Surgical device

ABSTRACT

A medical instrument comprising: (A) a first joint comprising a first member and a second member, the first member configured to be repositionable with respect to the second member in an X-Y plane; (B) a second joint operatively coupled to the first joint, the second joint comprising a third member and a fourth member, the third member configured to be repositionable with respect to the fourth member in a Y-Z plane perpendicular to the X-Y plane; and, (C) a controller operatively coupled to the first joint and the second joint, the controller including a first control configured to direct repositioning of at least one of the first member and the second member, and a second control configured to direct repositioning of at least one of the third member and the fourth member.

CROSS REFERENCE TO RELATED APPLICATIONS

The present application claims the benefit of U.S. Provisional PatentApplication Ser. No. 61/523,805, titled “LAPAROSCOPIC DEVICE,” which wasfiled on Aug. 15, 2011, the disclosure of which is hereby incorporatedby reference.

RELATED ART Field of the Invention

The present invention is directed to surgical equipment and, morespecifically, to surgical equipment that may be used in minimallyinvasive procedures. The disclosure also relates to surgical equipmentto facilitate the positioning and deployment of an atrial appendageocclusion device. In addition, the disclosure relates to surgicalequipment that is adapted to accommodate or work in tandem with flexibleendoscopes.

INTRODUCTION TO THE INVENTION

The exemplary embodiments disclosed herein include one or more active orpassive repositioning mechanisms. As will be discussed in more detailhereafter, an active repositioning mechanism provides for infiniteadjustments as the user is physically operating a control to directlymanipulate the repositioning of an end effector. In contrast, a passiverepositioning mechanism can be thought of as acting similar to a lightswitch, either off or on. In this manner, the passive repositioningmechanism either allows or disallows repositioning of the end effector,but is not responsible for actively manipulating the position of the endeffector. Put another way, the passive repositioning system allows forfree movement of the end effector within the end effector's range ofmotion when the mechanism is in the “on” position, but locks movement ofthe end effector within the end effector's range of motion when themechanism is in the “off” position. In exemplary form, a laparoscopicdevice may incorporate both an active and a passive repositioningmechanism to control movements in different directions, such as pitchand yaw.

The exemplary embodiments also include active repositioning mechanismsthat provide a certain motion conversion. In other words, a ninetydegree change in position of the controller would result in a forty-fivedegree change in position at the end effector. As disclosed herein,certain parameters may be modified to provide different motionconversion depending upon the end application and user preference.

It is a first aspect of the present invention to provide a medicalinstrument comprising: (a) a first joint comprising a first member and asecond member, the first member configured to be repositionable withrespect to the second member in an X-Y plane; (b) a second jointoperatively coupled to the first joint, the second joint comprising athird member and a fourth member, the third member configured to berepositionable with respect to the fourth member in a Y-Z planeperpendicular to the X-Y plane; and, (c) a controller operativelycoupled to the first joint and the second joint, the controllerincluding a first control configured to direct repositioning of at leastone of the first member and the second member, and a second controlconfigured to direct repositioning of at least one of the third memberand the fourth member.

In a more detailed embodiment of the first aspect, the first controlcomprises a passive control configured to be repositionable between afirst position, that allows free movement between the first member andthe second member within the X-Y plane, and a second position thatretards movement between the first member and the second member withinthe X-Y plane, and the second control comprises an active controlconfigured to be repositionable among an infinite number of positions,where each of the infinite number of positions orients the third memberwith respect to the fourth member in a different position within the Y-Zplane. In yet another more detailed embodiment, the passive controlincludes a lever repositionably mounted to a housing of the controller,the lever coupled to a passive control line, and the passive controlline is also coupled to a repositionable catch configured to engage atleast one of the first member and the second member to retard movementbetween the first member and the second member within the X-Y plane. Ina further detailed embodiment, the repositionable catch is biased, usinga spring, to retard movement between the first member and the secondmember within the X-Y plane, and the lever is configured to berepositionable to tension the passive control line to overcome the biasof the spring to allow movement between the first member and the secondmember within the X-Y plane. In still a further detailed embodiment, theinstrument further includes a longitudinal conduit extending between thecontroller and the first joint, wherein at least a portion of thepassive control line extends through the longitudinal conduit. In a moredetailed embodiment, the instrument further includes a longitudinalconduit extending between the controller and the first joint, where thefirst member is mounted to the controller, and the second member isrepositionably mounted to the first member. In a more detailedembodiment, the first member is elongated and includes an internalcavity that at least partially houses a repositionable catch to retardmovement between the first member and the second member within the X-Yplane, and at least one of the first member and the longitudinal conduithouses a spring biasing the repositionable catch to retard movementbetween the first member and the second member within the X-Y plane. Inanother more detailed embodiment, at least one of the first member andthe second member includes a projection, at least one of the firstmember and the second member includes a cavity configured to receive theprojection, the cavity is at least partially defined by a bearingsurface, and the projection is configured to contact the bearing surfacewhen movement occurs between the first member and the second memberwithin the X-Y plane. In yet another more detailed embodiment, the firstmember includes the cavity, the second member includes the projection,the repositionable catch includes at least one tooth, and the secondmember includes at least one tooth configured to engage the at least onetooth of the repositionable catch to retard movement between the firstmember and the second member within the X-Y plane. In still another moredetailed embodiment, the cavity comprises a first cavity and a secondcavity spaced apart and facing one another, the projection comprises afirst projection and a second projection spaced apart and facing awayfrom one another, the first cavity is configured to receive the firstprojection, and the second cavity is configured to receive the secondprojection.

In yet another more detailed embodiment of the first aspect, the firstmember comprises a clevis, and the second member comprises a pelvis. Instill another more detailed embodiment, the first control comprises apassive control configured to be repositionable between a firstposition, that allows free movement between the first member and thesecond member within the X-Y plane, and a second position that retardsmovement between the first member and the second member within the X-Yplane, the clevis includes an internal cavity that at least partiallyreceives a repositionable catch and a bias spring, the repositionablecatch comprises a portion of the first control, the first control alsoincludes an actuator repositionable mounted to the controller, and thefirst control further includes a tether concurrently coupled to theactuator and the repositionable catch. In a further detailed embodiment,the pelvis includes a first pelvis half and a second pelvis half, andthe first pelvis half and the second pelvis half are identical. In stilla further detailed embodiment, the active control includes an actuatorrepositionably mounted to a housing of the controller, the actuatoroperatively coupled to an active control line, and the active controlline is coupled to at least one of the third member and the fourthmember to control movement between the third member and the fourthmember within the Y-Z plane. In a more detailed embodiment, the actuatorincludes a wheel and a link plate, the wheel includes a spiral cavity,and the linkplate includes a projection configured to be received withinthe spiral cavity of the wheel. In a more detailed embodiment, theactuator includes a wheel and a link plate, the linkplate includes aspiral cavity, and the wheel includes a projection configured to bereceived within the spiral cavity of the linkplate. In another moredetailed embodiment, the actuator includes a wheel and a link plate, thelinkplate includes a cavity, and the wheel includes a spiral projectionconfigured to be received within the cavity of the linkplate. In yetanother more detailed embodiment, the actuator includes a wheel and alink plate, the wheel includes a cavity, and the linkplate includes aspiral projection configured to be received within the cavity of thewheel.

In a more detailed embodiment of the first aspect, the second controlcomprises an active control configured to be repositionable among aninfinite number of positions, where each of the infinite number ofpositions orients the third member with respect to the fourth member ina different position within the Y-Z plane, the second member is mountedto the third member, and the third member is repositionably mounted tothe fourth member. In yet another more detailed embodiment, the fourthmember is elongated and includes an internal cavity that at leastpartially houses a repositionable pull link, and the fourth memberincludes a channel configured to receive at least a portion of theactive control line. In a further detailed embodiment, the channelincludes a first arcuate segment and a second arcuate segment, theactive control line includes a first active control line and a secondactive control line, the first arcuate segment is configured to receivethe first active control line, the second arcuate segment is configuredto receive the second active control line, at least a portion of thefirst active control line is secured to the fourth member, and at leasta portion of the second active control line is secured to the fourthmember. In still a further detailed embodiment, at least one of thethird member and the fourth member includes a projection, at least oneof the third member and the fourth member includes a cavity configuredto receive the projection, the cavity is at least partially defined by abearing surface, and the projection is configured to contact the bearingsurface when movement occurs between the third member and the fourthmember within the Y-Z plane. In a more detailed embodiment, the fourthmember includes the cavity, and the third member includes theprojection. In a more detailed embodiment, the cavity comprises a firstcavity and a second cavity spaced apart and facing away from oneanother, the projection comprises a first projection and a secondprojection spaced apart and facing one another, the first cavity isconfigured to receive the first projection, and the second cavity isconfigured to receive the second projection. In another more detailedembodiment, the second control comprises an active control configured tobe repositionable among an infinite number of positions, where each ofthe infinite number of positions orients the third member with respectto the fourth member in a different position within the Y-Z plane, thethird member comprises a pelvis, and the fourth member comprises a yoke.In yet another more detailed embodiment, the active control includes anactuator repositionably mounted to a housing of the controller, theactuator operatively coupled to a first active control line and a secondactive control line, the yoke includes an internal cavity that at leastpartially receives a repositionable pull link, the yoke includes a firstchannel configured to receive at least a portion of the first activecontrol line, and a second configured to receive at least a portion ofthe second active control line, at least a portion of the first activecontrol line and the second active control line are secured to the yoke.In still another more detailed embodiment, the second member and thethird member are mounted to one another, and the second member and thethird member cooperate to forma pelvis.

In yet another more detailed embodiment of the first aspect, theactuator includes a first wheel, a first link plate, a second wheel, anda second link plate, the first and second wheels each include a spiralcavity, the first and second linkplates each include a projectionconfigured to be received within a respective spiral cavity of the firstand second wheels, the first active control line is coupled to the firstlink plate, and the second active control line is coupled to the secondlink plate. In still another more detailed embodiment, the first wheelis a mirror image of the second wheel. In a further detailed embodiment,the spiral cavity of each of the first and second wheels includes anarcuate wall that delineates the spiral cavity, and the projection ofeach of the first and second link plates includes a curved surface thatis configured to contact the arcuate wall of a respective spiral cavity.In still a further detailed embodiment, the first control comprises afirst passive control configured to be repositionable between a firstposition, that allows free movement between the first member and thesecond member within the X-Y plane, and a second position that inhibitsmovement between the first member and the second member within the X-Yplane, and the second control comprises a second passive controlconfigured to be repositionable between a first position, that allowsfree movement between the third member and the fourth member within theY-Z plane, and a second position that inhibits movement between thethird member and the fourth member within the Y-Z plane. In a moredetailed embodiment, the first passive control includes an actuatorrepositionably mounted to a housing of the controller, the actuatorcoupled to a first passive control line, and the first passive controlline is also coupled to at least one of the first member and the secondmember to retard movement between the first member and the second memberwithin the X-Y plane. In a more detailed embodiment, the actuator isconfigured to be repositionable to allow movement between the firstmember and the second member within the X-Y plane. In another moredetailed embodiment. In yet another more detailed embodiment, the firstmember is elongated and includes an internal cavity that at leastpartially houses a repositionable catch to retard movement between thefirst member and the second member within the X-Y plane, and at leastone of the first member and the longitudinal conduit houses a springbiasing the repositionable catch to retard movement between the firstmember and the second member within the X-Y plane.

In a more detailed embodiment of the first aspect, at least one of thefirst member and the second member includes a projection, at least oneof the first member and the second member includes a cavity configuredto receive the projection, the cavity is at least partially defined by abearing surface, and the projection is configured to contact the bearingsurface when movement occurs between the first member and the secondmember within the X-Y plane. In yet another more detailed embodiment,the first member includes the cavity, the second member includes theprojection, the repositionable catch includes at least one tooth, andthe second member includes at least one tooth configured to engage theat least one tooth of the repositionable catch to retard movementbetween the first member and the second member within the X-Y plane. Ina further detailed embodiment, the cavity comprises a first cavity and asecond cavity spaced apart and facing one another, the projectioncomprises a first projection and a second projection spaced apart andfacing away from one another, the first cavity is configured to receivethe first projection, and the second cavity is configured to receive thesecond projection. In still a further detailed embodiment, the firstmember comprises a clevis, and the second member comprises a pelvis. Ina more detailed embodiment, the clevis includes an internal cavity thatat least partially receives a repositionable catch and a bias spring,the repositionable catch comprises a portion of the first control, thefirst control also includes an actuator repositionable mounted to thecontroller, and the first control further includes a tether concurrentlycoupled to the actuator and the repositionable catch. In a more detailedembodiment, the pelvis includes a first pelvis half and a second pelvishalf, and the first pelvis half and the second pelvis half areidentical. In another more detailed embodiment, the second controlincludes an actuator repositionably mounted to a housing of thecontroller, the actuator operatively coupled to a passive control line,and the passive control line is coupled to at least one of the thirdmember and the fourth member to control movement between the thirdmember and the fourth member within the Y-Z plane. In yet another moredetailed embodiment, the actuator includes a depressible buttonextending through the housing of the controller that is configured toengage a receiver, the actuator includes at least one tooth, and thereceiver includes a at least one tooth configured to selectively engagethe at least one tooth of the actuator. In still another more detailedembodiment, an actuator is repositionably mounted to a housing of thecontroller, the actuator comprising a portion of the first control and aportion of the second control, the first passive control includes afirst receiver repositionably mounted to the housing of the controller,the first receiver operatively coupled to a first line mounted to atleast one of the first member and the second member, and the secondpassive control includes a second receiver repositionably mounted to thehousing of the controller, the second receiver operatively coupled to asecond line mounted to at least one of the third member and the fourthmember.

In yet another more detailed embodiment of the first aspect, theactuator comprises a depressible button that is biased by a spring, theactuator configured to be repositionable between a first position and asecond position, the first position allows free movement between thefirst member and the second member within the X-Y plane and allows freemovement between the third member and the fourth member within the Y-Zplane, the second position retards free movement between the firstmember and the second member within the X-Y plane and retards freemovement between the third member and the fourth member within the Y-Zplane, the actuator is lockable in the first position, the actuator doesnot engage the first receiver or the second receiver in the firstposition, and, the actuator engages the first receiver and the secondreceiver in the second position. In still another more detailedembodiment, the actuator comprises a depressible button that is biasedby a spring to engage the first receiver and the second receiver, thefirst and second receivers are rotationally repositionable along acommon spool extending internally within the controller when not engagedby the depressible button, and the first and second receivers are notrotationally repositionable along the common spool when engaged by thedepressible button. In a further detailed embodiment, the instrumentfurther includes an end effector operatively coupled to the first andsecond joints. In still a further detailed embodiment, the end effectorcomprises at least one of a surgical dissector, an ablation pen, anocclusion clip, an occlusion clip applicator, surgical forceps, surgicaljaws, a linear cutter, an ablation clamp, and an ablation rail. In amore detailed embodiment, the controller includes a third controloperatively coupled to the end effector. In a more detailed embodiment,the end effector comprises a clip deployment device, and the thirdcontrol includes a link that extends from the controller to the endeffector to control repositioning of at least a portion of the clipdeployment device. In another more detailed embodiment, the clipdeployment device include opposing jaws removably coupled to anocclusion clip, and the link is configured to be repositioned to removethe occlusion clip from being coupled to the opposing jaws. In yetanother more detailed embodiment, the opposing jaws each include anorifice through which a tether extends, the tethers are coupled to theocclusion clip, and the link is removable coupled to the tethers.

In yet another more detailed embodiment of the first aspect, the tethercomprises a suture loop, and the link interposes the suture loop and theocclusion clip. In yet another aspect of the invention, the end effectorcomprises a clip deployment device, and the third control includes alink that extends from the controller to the end effector to controlrepositioning of at least a portion of the clip deployment device.Moreover, in yet another detailed embodiment, the second joint includesa channel along which a pull link is configured to traverse, the pulllink being operatively coupled to the third control and the clipdeployment device, and the deployment device including at least two linkclips operatively coupled to the pull link, each of the at least twolink clips having a non-circular cam that rides upon a camming surfaceof at least one of two jaws, the at least two link clips configured topivot with respect to the two jaws until interaction between the cam andcamming surface inhibits further pivoting.

It is a second aspect of the present invention to provide a medicalinstrument comprising: (a) a controller at least partially housing aplurality of controls; (b) an elongated conduit operatively coupling thecontroller to a first joint and a second joint; (c) a first jointcomprising a first member and a second member, the first memberconfigured to be repositionable with respect to the second member in anX-Y plane; (d) a second joint operatively coupled to the first joint,the second joint comprising a third member and a fourth member, thethird member configured to be repositionable with respect to the fourthmember in a Y-Z plane perpendicular to the X-Y plane; and, (e) an endeffector operatively coupled to the first and second joints, where theplurality of controls includes a first control operatively coupled tothe first joint to control motion of the first member with respect tothe second member in the X-Y plane, a second control operatively coupledto the second joint to control motion of the third member with respectto the fourth member in the Y-Z plane, a third control operativelycoupled to the end effector control motion of at least a portion of theend effector.

In a more detailed embodiment of the second aspect, the instrumentfurther includes an occlusion clip removably mounted to the endeffector, wherein the plurality of controls includes a fourth control todismount the occlusion clip from the end effector. In yet another moredetailed embodiment, the first control comprises a passive controlconfigured to be repositionable between a first position, that allowsfree movement between the first member and the second member within theX-Y plane, and a second position that retards movement between the firstmember and the second member within the X-Y plane, and the secondcontrol comprises an active control configured to be repositionableamong an infinite number of positions, where each of the infinite numberof positions orients the third member with respect to the fourth memberin a different position within the Y-Z plane. In a further detailedembodiment, the third control comprises a second active controlconfigured to be repositionable among an infinite number of positions,where each of the infinite number of positions orients the end effectorin a different position. In still a further detailed embodiment, theinstrument further includes an occlusion clip removably mounted to theend effector, wherein the plurality of controls includes a fourthcontrol to dismount the occlusion clip from the end effector, whereinthe fourth control comprises a passive control configured eitherdismount or retain a connection between the end effector and theocclusion clip. In a more detailed embodiment, the first controlcomprises a first passive control configured to be repositionablebetween a first position, that allows free movement between the firstmember and the second member within the X-Y plane, and a second positionthat retards movement between the first member and the second memberwithin the X-Y plane, and the second control comprises a second controlconfigured to be repositionable between a first position, that allowsfree movement between the third member and the fourth member within theY-Z plane, and a second position that retards movement between the thirdmember and the fourth member within the Y-Z plane. In a more detailedembodiment, the third control comprises an active control configured tobe repositionable among an infinite number of positions, where each ofthe infinite number of positions orients the end effector in a differentposition.

In yet another more detailed embodiment of the second aspect, the firstcontrol comprises a first passive control configured to berepositionable between a first position, that allows free movementbetween the first member and the second member within at least ninetydegrees of the X-Y plane, and a second position that retards movementbetween the first member and the second member within the X-Y plane, andthe second control comprises a second control configured to berepositionable between a first position, that allows free movementbetween the third member and the fourth member within at least ninetydegrees of the Y-Z plane, and a second position that retards movementbetween the third member and the fourth member within the Y-Z plane. Instill another more detailed embodiment, the first control comprises apassive control configured to be repositionable between a firstposition, that allows free movement between the first member and thesecond member within at least ninety degrees of the X-Y plane, and asecond position that retards movement between the first member and thesecond member within the X-Y plane, and the second control comprises anactive control configured to be repositionable among an infinite numberof positions within at least ninety degrees of the Y-Z plane, where eachof the infinite number of positions orients the third member withrespect to the fourth member in a different position within the Y-Zplane. In a further detailed embodiment, the active control includes afirst wheel having a first spiral cavity formed therein and a secondwheel having a second spiral cavity formed therein, the first and secondspiral cavities being mirror images of one another, the active controlalso includes a first link plate coupled to a first link line and asecond link place coupled to a second link line, the first link plateincludes a first projection configured to be received within the firstspiral cavity, the second link plate includes a second projectionconfigured to be received within the second spiral cavity, the firstwheel and second wheel are coupled to one another so that rotation ofone wheel results in corresponding rotation of the other wheel, whererotation in a first direction causes tension on the first link line andnot on the second link line, but rotation in a second direction,opposite the first direction, causes tension on the second link line andnot on the first link line, and tension on the first link line causesmovement in a positive X direction within the Y-Z plane, while tensionon the second link line causes movement in a negative X direction withinthe Y-Z plane. In still a further detailed embodiment, the end effectorcomprises at least one of a surgical dissector, an ablation pen, anocclusion clip, an occlusion clip applicator, surgical forceps, surgicaljaws, a linear cutter, an ablation clamp, and an ablation rail.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is an elevated perspective view of an exemplary laparoscopicdevice in accordance with the instant disclosure.

FIG. 2 is an exploded view of a proximal end of the exemplarylaparoscopic device of FIG. 1 .

FIG. 3 is an elevated perspective view of the proximal end of theexemplary laparoscopic device of FIG. 2 , without the left side housing.

FIG. 4 is an elevated perspective view of the proximal end of theexemplary laparoscopic device of FIG. 2 , without the right sidehousing.

FIG. 5 is an elevated perspective view of the right and left sidehousings mounted to one another.

FIG. 6 is an underneath perspective view of the right and left sidehousings mounted to one another.

FIG. 7 is an elevated perspective view of an exemplary wheel of theexemplary laparoscopic device of FIG. 1 .

FIG. 8 is a profile view of the exemplary wheel of FIG. 7 .

FIG. 9 is an underneath perspective view of the exemplary wheel of FIG.7 .

FIG. 10 is a bottom view of the exemplary wheel of FIG. 7 .

FIG. 11 is an elevated perspective view from the right side of anexemplary link plate of the exemplary laparoscopic device of FIG. 1 .

FIG. 12 is an elevated perspective view from the left side of theexemplary link plate of FIG. 11 .

FIG. 13 is an elevated perspective view from the front of the exemplarylink plate of FIG. 11 .

FIG. 14 is a magnified profile view, with the right side housingremoved, showing the interaction between a wheel and a link plate at afirst position.

FIG. 15 is a magnified profile view, with the right side housingremoved, showing the interaction between a wheel and a link plate at asecond position.

FIG. 16 is a magnified profile view of a wheel and link plate, with theright side housing removed, showing the interaction between a wheel anda link plate at a third position.

FIG. 17A is a profile view showing three vertical positions of the endeffector achieved using an active repositioning mechanism.

FIG. 17B is an overhead view showing three horizontal positions of theend effector (shown using changes in position of the semi-rigid conduitwith respect to the end effector) achieved using a passive repositioningmechanism.

FIG. 18 is a magnified profile view, with the right side housingremoved, showing an angle θ between the catch and the trench.

FIG. 19 is an elevated perspective view of the outside of the right sidehousing of the exemplary laparoscopic device of FIG. 1 .

FIG. 20 is an elevated perspective view of the inside of the right sidehousing of the exemplary laparoscopic device of FIG. 1 .

FIG. 21 is an elevated perspective view of the outside of an exemplarylever of the exemplary laparoscopic device of FIG. 1 .

FIG. 22 is a profile view of the exemplary lever of FIG. 21 .

FIG. 23 is an elevated perspective view of the inside of the exemplarylever of FIG. 21 .

FIG. 24 is an elevated perspective view of the outside of the left sidehousing of the exemplary laparoscopic device of FIG. 1 .

FIG. 25 is an elevated perspective view of the inside of the right sidehousing of the exemplary laparoscopic device of FIG. 1 .

FIG. 26 is a magnified profile view of an interior of a proximal portionof the exemplary controller of the laparoscopic device of FIG. 1 , withthe left side housing removed.

FIG. 27 is a magnified profile view of an interior of a proximal portionof the exemplary controller of FIG. 1 , with the right side housingremoved.

FIG. 28 is an elevated perspective view of an exemplary handle mechanismof the laparoscopic device of FIG. 1 .

FIG. 29 is an underneath perspective view of the exemplary handlemechanism of FIG. 28 .

FIG. 30 is an elevated perspective view of the interior of the exemplarycontroller and proximal portion of the conduit of the exemplarylaparoscopic device of FIG. 1 , with the left side housing removed.

FIG. 31 is an elevated perspective view of the interior of the exemplarycontroller and proximal portion of the conduit of the exemplarylaparoscopic device of FIG. 1 , with the right side housing removed andan exemplary cap installed.

FIG. 32 is an elevated perspective view of the interior of the exemplarycontroller and proximal portion of the conduit of the exemplarylaparoscopic device of FIG. 1 , with the right side housing removed andan exemplary cap removed.

FIG. 33 is a longitudinal cross-sectional view of an alternate exemplaryconduit for use with the laparoscopic device of FIG. 1 .

FIG. 34 is an exploded view of the distal end of the exemplarylaparoscopic device of FIG. 1 .

FIG. 35 is an elevated perspective view of an exemplary clevis of theexemplary laparoscopic device of FIG. 1 .

FIG. 36 is an elevated perspective view of an exemplary clevis of FIG.35 , without the top housing.

FIG. 37 is an overhead view of an exemplary clevis of FIG. 36 .

FIG. 38 is an elevated perspective view of a bottom housing of theexemplary clevis of FIG. 35 .

FIG. 39 is an elevated perspective view of an exemplary tooth receiverof the exemplary laparoscopic device of FIG. 1 .

FIG. 40 is a front, profile view of the exemplary tooth receiver of FIG.39 .

FIG. 41 is a rear, profile view of the exemplary tooth receiver of FIG.39 .

FIG. 42 is an elevated perspective view of an exemplary clevis of FIG.35 , without the top housing, and with a pair of toothed plates andpelvis halves.

FIG. 43 is an elevated perspective view of an exemplary clevis of FIG.35 , without the top housing, and with single toothed plate and singlepelvis half.

FIG. 44 is an elevated perspective view of an exemplary toothed plate ofthe exemplary laparoscopic device of FIG. 1 .

FIG. 45 is an outside profile view of an exemplary pelvis half of theexemplary laparoscopic device of FIG. 1 .

FIG. 46 is a front profile view showing the pelvis halves of FIG. 42assembled.

FIG. 47 is an overhead view of the pelvis halves of FIG. 46

FIG. 48 an inside elevated perspective view of an exemplary pelvis halfof the exemplary laparoscopic device of FIG. 1 .

FIG. 49 is an elevated perspective view of an exemplary repositionablejaw assembly of the exemplary laparoscopic device of FIG. 1 .

FIG. 50 is an elevated perspective view of an exemplary yoke and pulllink of the exemplary laparoscopic device of FIG. 1 .

FIG. 51 is an elevated perspective view from the proximal end of theexemplary yoke of FIG. 50 .

FIG. 52 is a horizontal cross-sectional view of the exemplary yoke andpull link of FIG. 50 .

FIG. 53 is a horizontal cross-sectional view of the exemplary yoke ofFIG. 50 .

FIG. 54 is an elevated perspective view of the pull link of FIG. 50 .

FIG. 55 is a horizontal cross-sectional view of the exemplary yoke andpull link coupled to exemplary link plates and link clips.

FIG. 56 is an elevated perspective view of the exemplary pull linkcoupled to exemplary link plates and link clips.

FIG. 57 is an elevated perspective view of the exemplary link platescoupled to the exemplary link clips of FIG. 56 .

FIG. 58 is an outside perspective view of an exemplary left side jaw ofthe exemplary laparoscopic device of FIG. 1 .

FIG. 59 is an inside perspective view of the exemplary left side jaw ofFIG. 58 .

FIG. 60 is an overhead view showing the position of the jaws and variousother distal end components of the exemplary laparoscopic device of FIG.1 in a most compact widthwise orientation.

FIG. 61 is an overhead, magnified view of the jaws and link clips ofFIG. 60 .

FIG. 62 is an overhead view showing the position of the jaws and variousother distal end components of the exemplary laparoscopic device of FIG.1 as the pull link is initially moved proximally.

FIG. 63 is an overhead, magnified view of the jaws and link clips ofFIG. 62 .

FIG. 64 is an overhead view showing the position of the jaws and variousother distal end components of the exemplary laparoscopic device of FIG.1 as the pull link is moved farther proximally that in FIG. 62 .

FIG. 65 is an overhead, magnified view of the jaws and link clips ofFIG. 64 .

FIG. 66 is an overhead view showing the position of the jaws and variousother distal end components of the exemplary laparoscopic device of FIG.1 as the pull link is moved to its most proximal position to fully openthe jaws.

FIG. 67 is an overhead view showing the position of the jaws and variousother distal end components if the exemplary laparoscopic device of FIG.1 did not include a pivot point between the jaws and link clips.

FIG. 68 is a perspective view of an exemplary clamp in an open positionthat may be used with the exemplary laparoscopic device of FIG. 1 .

FIG. 69 is a perspective view of the exemplary clamp of FIG. 68 in aclosed position.

FIG. 70 is a cross-sectional view of the exemplary clamp of FIG. 68 inits open configuration, showing the wire member, rigid tubular members,and the urging members.

FIG. 71 is a cross-sectional view of the exemplary clamp of FIG. 69 inits closed configuration, showing the wire member, rigid tubularmembers, and the urging members.

FIG. 72 is a perspective view of the exemplary claims of FIGS. 68-71 andshowing the ability to close in a non-parallel fashion.

FIG. 73 is a perspective view of the first stage of assembly of analternate embodiment of a clamp, showing a wire member surrounded byrigid tubular members.

FIG. 74 is a perspective view of the second stage of assembly of theclamp of FIG. 73 , in which platens have been added over the rigidtubular members.

FIG. 75 is a perspective view of the clamp of FIGS. 73 and 74 , once anouter fabric covering has been disposed over the entire surface of theclamp.

FIG. 76 is an elevated perspective view of an alternate exemplarycontroller that may be used with the laparoscopic device of FIG. 1 .

FIG. 77 is an elevated perspective view of the alternate exemplarycontroller of FIG. 76 , shown without the left side housing.

FIG. 78 is a magnified, perspective view of the interior of a distalportion of the alternate exemplary controller of FIG. 76 .

FIG. 79 is a profile view of the structure shown in FIG. 78 with thebutton shown in its highest vertical position.

FIG. 80 is a profile view of the structure shown in FIG. 78 with thebutton shown depressed in its lowest vertical position.

FIG. 81 is a magnified, perspective view of the interior of a distalportion of the alternate exemplary controller of FIG. 76 , shown withoutthe button and first toothed assembly.

FIG. 82 is a magnified, perspective view of the interior of a distalportion of the alternate exemplary controller of FIG. 76 , shown withoutthe button.

DETAILED DESCRIPTION

The exemplary embodiments of the present disclosure are described andillustrated below to encompass surgical equipment and, morespecifically, to surgical equipment that may be used in minimallyinvasive procedures. The disclosure also relates to surgical equipmentto facilitate the positioning and deployment of an atrial appendageocclusion device. In addition, the disclosure relates to surgicalequipment that is adapted to accommodate or work in tandem with flexibleendoscopes. Of course, it will be apparent to those of ordinary skill inthe art that the embodiments discussed below are exemplary in nature andmay be reconfigured without departing from the scope and spirit of thepresent disclosure. However, for clarity and precision, the exemplaryembodiments as discussed below may include optional steps, methods, andfeatures that one of ordinary skill should recognize as not being arequisite to fall within the scope of the present disclosure.

Referencing FIGS. 1-6 , an exemplary laparoscopic device 100 comprises acontroller 110 mounted to a proximal portion of a semi-rigid conduit 112that is relatively linear. The controller 110 includes various controlsin order to manipulate a repositionable mechanism 116 operativelycoupled to an end effector 118, where the repositionable mechanism ismounted to a distal portion of the conduit 112. In this exemplaryembodiment, the repositionable mechanism 116 is coupled to an endeffector comprising a clip deployment device 118. But as will bediscussed in later embodiments, the end effector 118 may comprise anynumber of devices such as, without limitation, forceps, ablation rails,jaws, linear cutters, ablation pens, ablation clamps, illuminateddissectors, and non-illuminated dissectors.

The exemplary repositionable mechanism 116 incorporates an activemechanism and a passive mechanism. It should be noted that the activemechanism is operative to control the pitch (i.e., up and down) of theend effector 118, while the passive mechanism is operative to controlthe yaw (i.e., side to side) of the end effector. However, as will beevident from the following disclosure, the repositionable mechanism 116in an alternate exemplary embodiment may comprise only active or passivemechanisms. Conversely, the repositioning mechanism 116 in furtheralternate exemplary embodiments may utilize a passive mechanism tocontrol the pitch (i.e., up and down) of the end effector 118, while anactive mechanism is operative to control the yaw (i.e., side to side) ofthe end effector. Those skilled in the art will understand that thefollowing description is one but of a plurality of configurationsincorporating active and passive mechanisms to control the motion of anend effector 118 in two planes.

The controller 110 comprises a right side housing 130 and a left sidehousing 132 that cooperatively define an internal cavity andcorresponding openings to accommodate throughput of certain controls. Afirst of these openings is a dorsal opening 134 that accommodatesthroughput of a pair of wheels 136, 138 that are rotationallyrepositionable along a lateral axis.

Referring to FIGS. 7-10 , each wheel 136, 138 includes a contact face140 adapted to be contacted by a user in order to rotate the wheel. Thecontact face 140 includes a series of circumferentially distributeddepressions 142 interposed by a series of knurls 144 to facilitate gripbetween the user and the wheel 136, 138. Each knurl 144 is sloped tomatch the contour of the wheel 136, 138, which decreases from a maximumwhere the contact face 140 abuts an interior face 146. Radially insetfrom the depressions 142 and the knurls 144 is a planar ring surface 148that circumferentially delineates the outer boundary of a ring-shapedexterior cavity 152. A pair of sloped surfaces 154, 156 inset from thering surface 148 and axially spaced from one another operate toconstrict the diameter of the cavity 152 when moving axially, deeperinto the cavity. The cavity 152 is also partially delineated by a hollowaxle 158 that extends from the center of each wheel 136, 138. This axle158 is circumferentially surrounded at its base by a circular plateau162, where the axle and plateau cooperate to incrementally increase theradial dimension of the ring-shaped cavity 152. An interior of the axle158 defines a cylindrical cavity 166 that continues this cylindricalshape until reaching an interior midpoint where the cavity takes on asemicircular shape that extends through to the interior surface 146. Asemicircular projection 170 adjacent to the cavity 166 extends generallyperpendicularly away from the interior surface 146. The interior surface146 also includes a spiral trench 172 that is distributed approximatelytwo hundred and twenty degrees around the projection 170. In thismanner, the radial distance between the trench 172 and the projection170 gradually changes until reaching a maximum and minimum at the endsof the trench.

Referencing FIGS. 11-13 , the wheels 136, 138 are operatively coupled tothe repositionable mechanism 116 and operate to control pitch of therepositionable mechanism. In order to control pitch of therepositionable mechanism 116, each wheel 136, 138 is coupled to a linkplate 180 that converts the rotational motion of the wheel intolongitudinal motion along a longitudinal axis extending along the lengthof the conduit 112. In particular, each link plate 180 comprises a keyshape having a planar section 182 and a plurality of stamped openings184, 186, 188. The first of these stamped openings 184 has a horseshoeshape that creates a projection extending into the opening. Thisprojection is thereafter deformed by bending the projectionapproximately ninety degrees to create a catch 190 that extendsperpendicularly away from the planar section 182. The second opening 186has a generally oval shape with circular ends and is provided in orderto reduce the weight of the link plate 180 and provide a complementaryopening for the semicircular projection 170 of a corresponding wheel136, 138 (see FIGS. 8-10 ). The third opening 188 has a widthwisedimension that is substantially shorter than the vertical dimension tocreate an elongated, generally rectangular opening with rounded corners.This third opening 188 provides a throughput for a connection wire 194and cooperates with a half-loop 196 to secure the connection wire to thelink plate 180. In particular, the end of the planar section 182 isdeformed to create the half-loop 196, where the connection wire 194 isthreaded on the interior (i.e., concave aspect of the half-loop) of thehalf loop and extends through the third opening 188. In this exemplaryembodiment, the connection wire 194 includes a cylindrical sleeve 198that is secured to the wire so that lateral movement between the sleeveand wire does not occur. The sleeve 198 is dimensioned to allow forthroughput of the sleeve and connection wire 194 through the thirdopening 188. In particular, after throughput of the sleeve 198 andconnection wire 194 through the third opening 188, the sleeve 198 ispositioned longitudinally against the link plate 180 and abuts the halfloop 196. Specifically, the sleeve 198 is dimensioned so that the sleevecannot pass through the half loop 196 when positioned longitudinallyagainst the link plate 180. In this manner, repositioning of theconnection wire 194 may be accomplished by repositioning the link plate180 to place the connection wire 194 in tension. Each link plate 180also includes a spacer flange 200 that extends above the second opening186. The spacer flange 200 comprises a longitudinal S-shape bend that isapplied to the top of the key-shape. This flange 200 cooperates with acounterpart flange 200 of another link plate 180 to ensure properspacing between adjacent link plates.

Referring to FIGS. 2, 3, and 7-17 , assembly of the wheels 136, 138 andlink plates 180 provides for a means for repositioning therepositionable mechanism 116 upward or downward simply by rotating thewheels in a clockwise or counterclockwise direction. In particular, thelink plates 180 are assembled back to back, with one of the link plates180 being inverted, so that the flanges 200 face inward toward oneanother. In this manner, the flange 200 of a first link plate 180 abutsthe planar surface 182, while the second link plate flange 200 abuts theplanar surface 182 of the first link plate. In this orientation, thecatches 190 of each link plate 180 extend outward, away from oneanother. More specifically, the catches 190 (and a portion of the linkplates 180 themselves) are sandwiched between the interior faces 146 ofthe wheels 136, 138 and are received within a respective spiral trench172 of the adjacent wheel 136, 138. At the same time, when the interiorfaces 146 are brought closer together, semicircular projections 170 ofthe wheels 136, 138 are aligned so that the planar surfaces of theprojections abut one another, thereby forming a cylindrical projectionthat extends through both second openings 186 of the link plates 180.

Referring specifically to FIGS. 14-17A, rotation of the wheels 136, 138in concert is operative to change the vertical orientation of therepositionable mechanism 116. For instance, starting at position A asshown in FIG. 17A, rotation of the wheels 136, 138 from the top, movingdistally and downward, is operative to pull the first link plate 180proximally, while pushing the second link plate distally. In otherwords, the rotational motion of the wheels 136, 138, via the interfacebetween the spiral trench 172 and the catches 190, is transformed intohorizontal motion of the link plates 180. More specifically, the catch190 of the first link plate 180 abuts an end of the spiral trench 172 ofthe first wheel 136 that operates to limit the vertical travel of therepositionable mechanism 116. In this exemplary embodiment, the verticaltravel is limited so that the maximum angle of deflection is negativesixty degrees from horizontal. In order to bring the repositionablemechanism 116 upward, the wheels 136, 138 are rotated clockwise, therebychanging the position of the spiral trench 172 with respect to the catch190. In exemplary form, the catch 190 rides within the spiral trench 172and is maintained in a constant horizontal orientation with respect tothe trench because of the tension of the connection wire 194 pulling onthe link plate 180 proximally. But as the wheels 136, 138 are rotatedclockwise from position A, the distance from the center of the wheels tothe spiral trench 172 occupied by the catch 190 decreases, therebyrepositioning the first link plate 180 proximally with respect to thewheels. Continued rotation of the wheels 136, 138 clockwise(approximately ½ a turn) is operative to raise the repositionablemechanism 116 upward to reach position B (see FIG. 17A), where therepositionable mechanism is angled zero degrees from horizontal. Furtherclockwise rotation of the wheels 136, 138 clockwise (approximately ½ aturn) is operative to raise the repositionable mechanism 116 upward toreach position C (see FIG. 17A), where the repositionable mechanism isangled sixty degrees from horizontal. Conversely, rotation of the wheels136, 138 from the top, moving proximally and downward, is operative topush the first link plate 180 distally, while pulling the second linkplate proximately, thereby lowering the repositionable mechanism 116 byway of the connection wires 194.

The rotation of the wheels 136, 138 is proportional to the pivotingmotion of the repositionable mechanism 116. It should be noted thatposition C corresponds to the catch 190 being adjacent the opposite endof the spiral trench 172, which is operative to set the vertical travellimit of sixty degrees from horizontal. Simply put, by rotating thewheels 136, 138 approximately 360 degrees, the repositionable mechanismis operative to travel 120 degrees. Accordingly, the wheels 136, 138 areoperative to convert three degrees of rotational motion into one degreeof pivoting motion. And the shape of the spiral trench 172 may bemodified to increase or decrease the conversion between rotationalmotion of the wheels 136, 138 to pivoting motion of the repositionablemechanism 116. For example, the pitch of the spiral trench 172 may setso that two full rotations of the wheels 136, 138 are necessary to movefrom one endpoint to the opposite endpoint of the trench. In such anexample, the conversion would be six degrees of rotational motiontranslating into one degree of pivoting motion (presuming the maximumpivoting range was 120 degrees). In other words, it would take two fullrotations of the wheels 136, 138 to move between the pivotal endpointsof the repositioning mechanism 116. In contrast, the pitch of the spiralmay be set to extend around one third of the wheels 136, 138 so that theconversion would be one to one (i.e., one degree of rotational motiontranslates into one degree of pivoting motion).

The spiral trench 172 can also be set to have variable rates as thewheels 136, 138 are turned. In other words, the distance changes fromthe center of the wheels 136, 138 to the trench 172 is not constantalong all 360 degrees. For example, the middle section of the trench 172may have a pitch that correlates to two degrees of rotation beingconverted into one degree of pivotal motion of the repositionablemechanism 116 within ±20 degrees from horizontal (i.e., zero degrees).But beyond this point, the trench 172 pitch is decreased so that thefinal 40 degrees of travel (between 20 to 60 degrees and −60 to −20degrees) is achieved by turning the wheels three degrees to achieve onedegree of pivotal motion. Those skilled in the art will understand thatvarious combinations can be achieved by changing the pitch of the trench172 and having one or more trench sections with different pitches.

Referring to FIG. 18 , the pitch (i.e., angle θ) of the spiral trench172 also influences whether the repositioning mechanism 116 isself-locking. In the context of this disclosure, self-locking refersautomatically inhibiting movement. In exemplary form, as the angle θ ofthe spiral trench 172 increases (and the conversion from rotationdegrees to pivoting degrees decreases), the resistance to movement ofthe catch 190 within the trench 172 decreases. In exemplary form, whenthe angle θ between the catch and trench is ninety degrees, resistanceis maximized. In contrast, when the angle θ between the catch and trenchis zero, the resistance is minimized. At some angle θ between zero andninety, the resistance is great enough to provide a self-lockingfeature. In other words, to achieve a self-locking feature, theresistance to movement of the catch 190 within the trench 172 must begreater than the tensile force T on the connection wire 194. The morespiral turns that comprise the trench 172, the greater the angle θ. Theless spiral turns that comprise the trench 172, the lesser the angle θand the greater the chance of a back load causing the wheels 136, 138 torotate. In exemplary from, the spiral trench 172 has an angle ofapproximately 80-85 degrees. This angle is sufficient to provide aself-locking feature so that a back load (a force applied directly tothe repositioning mechanism 116 that is transmitted along the connectionwire 194) is inoperative to cause the wheels 136, 138 to rotate, therebyinhibiting pivoting motion of the repositioning mechanism. However, itmay be desirable to avoid a self-locking feature, at which point theshape of the catch 190 and trench 172 can be changed to decrease thefriction therebetween, including decreasing the spiral turns to decreasethe angle θ.

As discussed above, the wheels 136, 138 are rotated and act as cams toreposition the link plates 180, which in turn repositions the connectionwires 194. As will be discussed in more detail hereafter, the connectionwires 194 are mounted to the yoke 614 that rotates with respect to thepelvis halves 594, 596 in order to provide an infinite number ofpositions within the range of motion afforded by the spiral trench 172of the wheels 136, 138. For purposes of this disclosure, this mechanismis referred to as an active repositioning mechanism because it is theaffirmative rotation of the wheels that directly results in aproportional movement of the yoke 614 with respect to the pelvis halves594, 596. Moreover, a user of the wheels 136, 138 is operative to lockthe position of the end effector 118 simply by discontinuing rotation ofthe wheels. In exemplary form, the resistance to rotation of the wheels136, 138 is the result of the angle between the trench 172 boundariesand the catch 190 of the link plates 180. Based upon the structure ofthis mechanism, a user of the wheels 136, 138 actively controls theposition of the end effector 118.

In an alternate exemplary embodiment, the active mechanism may beremotely controlled so that a user does not physically touch the wheels136, 138, but instead operates a controller remote from the wheels. Thecontroller is in communicatively coupled to a motor or actuatoroperative to drive the wheels in the desired direction, thereby allowingremote control of the wheels.

In a further alternate exemplary embodiment, the active mechanism isremoved from the controller 110 and repositioned distally at the distalend of the conduit 112, proximate the end effector 118. In such anembodiment, the active mechanism is exposed and available to bemanipulated by a robotic appendage, thereby repositioning the endeffector locally (with respect to the controller 110). Morespecifically, the wheels would be rotated by the robotic appendage inorder to reposition the end effector 118.

As will be discussed in more detail hereafter, this active mechanism isin contrast to a passive mechanism having “on” and “off” functionalitythat allows certain movement of the end effector 118 or disallows thissame movement. Because the mechanism does not affirmatively allowcontrol of incremental motion of the end effector 118, but rather onlyoperates to allow or disallow motion, the mechanism is referred toherein as passive.

Referring back to FIGS. 1, 5, and 19-23 , the right side housing 130 ofthe controller 110 also includes an exterior depression 230 and a pairof through openings 232, 234 to accommodate a repositionable lever 236that is part of the passive mechanism. As will be discussed in moredetail hereafter, the repositionable lever 236 may be manipulated tolock and unlock the repositionable mechanism 116 in order to provide foror constrain lateral adjustability of the end effector 118. The firstthrough opening 232 is defined by a cylindrical bearing 238 that extendsperpendicularly away from the housing 130. The bearing 238 includes anexterior circular bearing surface 240 and an interior circular bearingsurface 242 that are sandwiched by the lever 236. In this manner, thelever 236 rotates around the exterior bearing surface 240 and rotateswithin the interior bearing surface 242. The lever 236 includes atapered appendage 248 integrally formed with a cupped cover 250. Aninterior of the cupped cover 250 is hollowed to define an internalcavity 252 delineated by a peripheral wall 254 having a generallycircular shape at one end and an arcuate shape (but not rounded) at theother end. A cylindrical upstanding projection 256 extendsperpendicularly away from the interior of the cupped cover 250 and isgenerally equidistantly spaced from the circular portion of theperipheral wall 254, but extends above the height of the peripheralwall. A second cylindrical upstanding projection 258 is formed at acorner of the arcuate end of the peripheral wall 254. This secondcylindrical projection 258 extends perpendicularly away from theinterior of the cupped cover 250 (and parallel to the first cylindricalprojection 256) and extends above the height of the first cylindricalprojection 256. The first cylindrical projection 256 is received withinthe first through opening 232 of the cylindrical bearing 238, while thesecond cylindrical projection 258 is received within the second throughopening 234. The circular cross-section of the first cylindricalprojection 256 and the first through opening 232 and the dimensions ofeach allow for rotation of the rotation of the first cylindricalprojection within the first through opening without significant radialplay that would otherwise cause the lever 236 to not consistently rotatearound a single rotational axis. Conversely, the second through opening234 is elongated and takes on an arcuate path that tracks the movementof the second cylindrical projection 258. More specifically, the secondthrough opening 234 includes rounded ends that generally match thecurvature and dimensions of second projection 258, but allow for playbetween the bounds of the opening and the projection so the projectioncan move within the opening. At the same time, the height of the secondthrough opening 234 is slightly larger than the diameter of the secondprojection 258, while the arcuate path of the through opening tracks theposition of the second projection as the lever 236 rotates about thehousing 130. The bounds or endpoints of the opening 234 provide a limiton the rotational repositioning of the lever 236. As will be discussedin more detail hereafter, the bounds provide a locked and an unlockedposition that corresponds to locked or free lateral adjustability of theend effector 118. More specifically, the lever 236 is coupled to aconnection wire 261 by winding the connection wire around the firstcylindrical projection 256. The remaining exterior surface 260 of theright side housing 130 is convex and includes a number of additionalfeatures.

Referring specifically to FIGS. 2, 19, and 20 , the additional featuresinclude an enlarged section 264, proximate a distal end 262, which isrounded on its underside. This enlarged section 264 tapers proximallyand distally to transition into a proximal neck 266 and a distal flange268. The distal flange 268 interposes the enlarged section 264 and asemi-circular adapter 270. As will be discussed in more detailhereafter, the adapter 270 includes a pair of detents 272 that engagethe semi-rigid conduit 112 in order to inhibit longitudinal movement ofthe conduit with respect to the controller 110. Both detents 272 extendin parallel to one another and extend from an interior circumferentialsurface 278 of the adapter 270 that communicates with an exterior of thesemi-rigid conduit 112. The exterior of the adapter 270 is smooth andsemicircular in order to receive a cylindrical cap 282 thatcircumscribes the exterior of the adapter 270.

Referring to FIGS. 5 and 6 , the exterior surface 260 of the right sidehousing 130 also includes a sloped dorsal surface 284 (sloped downwardfrom distal to proximal) that arcuately transitions into a sculptedrecess 286 and a bowed medial surface 288 that both transition to arelatively planar ventral surface 290. As will be discussed in moredetail hereafter, the ventral surface 290 of the right side housing 130cooperates with a corresponding ventral surface 294 of the left sidehousing 132 to partially delineate a handle mechanism port 296 and ahandle retention port 298. Both ports 296, 298 are open to the interiorsof the respective housings 130, 132. The surfaces 284, 288, 290 convergeat the proximal end to partially define a proximal port 300 that is alsoopen to the interior of the housing 130.

Referring back to FIG. 20 , the interior of the right side housingincludes a series of hollow cylinders 304 that extend generallyperpendicularly from the interior surface and are generally parallel toone another. Each cylinder 304 is sized to receive a threaded fastenerin order to mount the respective housings 130, 132 to each other. Inexemplary form, two of the hollow cylinders 304 are spaced apart fromone another by a cross-member 306 having a semicircular cutout.Extending proximally from these hollow cylinders 304 is a pair ofstiffening ribs 308 that are partially interposed by a projection 310having a corresponding shape that defines the exterior depression 230.At the proximal end of the projection 310 are another pair of hollowcylinders 304. These hollow cylinders 304 are followed by another pairof stiffening ribs 308 that interpose a third set of hollow cylinders304. This pair of hollow cylinders 304 comprising the third set isspaced apart from one another by a cross-member 312 that includes anoblong projection 314 extending proximal-to-distal. As will be discussedhereafter, the oblong projection 314 is hollowed and includes acorresponding cavity 316 that receives a portion of the handle mechanism320 (see FIG. 26 ). Finally, a proximal stiffening rib 308 interposesthe third set of cylinders and a proximal single cylinder 304. A portionof the perimeter of the interior surface of the right side housing 130includes a recessed ledge 322 that is received within a correspondingchannel 324 (see FIG. 25 ) of the left side housing 132 in order toalign the housings 130, 132. And the interior of the right side housingalso includes a detent 326 that extends into the handle retention port298 and is used to retain the handle mechanism in a set position.

Referring to FIGS. 5, 6, 24, and 25 , the left side housing 132 issimilar to the right side housing 130 and includes a convex exteriorsurface 340 and a concave interior surface 342. The interior andexterior surfaces 340, 342 converge to partially define the dorsalopening 134, the handle mechanism port 296, the handle retention port298, and the proximal port 300.

The left side housing 132 of the controller 110 includes an enlargedsection 354, proximate a distal end 352 that is rounded on itsunderside. This enlarged section 354 tapers proximally and distally totransition into a proximal neck 356 and a distal flange 358. The distalflange 358 interposes the enlarged section 354 and a semi-circularadapter 360. The exterior of the adapter 360 is smooth and semicircularin order to receive the cylindrical cap 282 that circumscribes theexterior of the adapter 360.

The exterior surface 340 of the left side housing 132 also includes asloped dorsal surface 364 (sloped downward from distal to proximal) thatarcuately transitions into a sculpted recess 366 and a bowed lateralsurface 368 that both transition to a relatively planar ventral surface294. The bowed lateral surface 368 includes a plurality of through holes370 that are partially bounded by corresponding hollow cylinders 372that extend into the interior of the left side housing 132. Thesecylinders 372 are adapted to be aligned with the hollow cylinders 304 ofthe right side housing 130 and receive corresponding fasteners (notshown) in order to mount the housings to each other. Moreover, theventral surfaces 290, 294 of the housings 130, 132 cooperate todelineate the handle mechanism port 296 and the handle retention port298. The surfaces 364, 368, 294 converge at the proximal end topartially define the proximal port 300 that is also open to the interiorof the housing 132.

The interior of the left side housing 132 includes several hollowcylinders 372 that extend generally perpendicularly from the interiorsurface 342 and are generally parallel to one another. In exemplaryform, two of the hollow cylinders 372 nearest the distal end are spacedapart from one another and have generally the same height. Travelingproximally from these hollow cylinders 372 is a pair of stiffening ribs378 that are partially interposed by a cylindrical projection 380 havinga hollow interior cavity 382 and a longitudinal height approximating theheight of the ribs. Traveling proximally from the stiffening ribs 378are a pair of hollow cylinders 372 that are spaced apart from oneanother by an L-shaped cross-member 383. It should be noted that thedorsal cylinder 372 has a height relatively the same as the height ofthe tall portion of the cross-member, while the ventral cylinder has aheight relatively the same as the height of the lower portion of thecross-member. Continuing to travel proximally from the L-shapedcross-member 383, a larger hollow cylinder 384 intersects a stiffeningrib 379 having a notch cut out of it to resemble the L-shapedcross-member. Further traveling proximally from the larger cylinder 384is an L-shaped cross-member 385, followed by a pair of hollow cylinders372 comprising a third set spaced apart from one another by across-member 386 that includes an oblong projection 388 extendingproximal-to-distal. As will be discussed hereafter, the oblongprojection 388 is hollowed and includes a corresponding cavity 390 thatreceives a portion of the handle mechanism 320. Finally, a proximalstiffening rib 392 interposes the third set of cylinders and a proximalsingle cylinder 394. A portion of the perimeter of the interior surface340 of the left side housing 132 includes channels 324 that receive therecessed ledge 322 of the right side housing 130.

Referencing FIGS. 2 and 26-29 , the handle mechanism 320 comprises arepositionable handle 400, a drive link 402, a return spring 404, and adraw plate 406. As will be discussed in more detail hereafter, the drawplate 406 is coupled to a draw wire 408 operatively coupled to the clipdeployment device 118 in order to selectively open and close anocclusion clip 1160 (see FIG. 75 ), such as during an atrial appendageocclusion clip deployment surgical procedure. A more detailedexplanation of the respective components of the handle mechanism 320follows.

The repositionable handle 400 includes an arcuate, ventral grippingsurface 414 having a series of convex bumps 416 longitudinally spacedapart to facilitate gripping by a user. At the same time, the ventralgripping surface 414 tapers in the medial-to-lateral direction from amaximum in between the proximal and distal ends. Opposite the ventralgripping surface 414 is a corresponding interior surface 418 from whicha pair of spaced apart, parallel vertical walls 420, 422 extend. Thevertical walls 420, 422 are also connected to one another via aplurality of cross walls 424. The proximal cross wall is also connectedto an upstanding loop 428 that provides a through opening 430 in themedial-to-lateral direction. Extending distally from the loop 428, thewalls 420, 422 gradually increase in height and extend distally beyondthe ventral gripping surface 414. In particular, the distal most portionof the walls 420, 422 each includes a rounded, dorsal end having acircular opening 434 extending in the medial-to-lateral direction. Adistal wall 436 spans between the walls 420, 422 at the distal end andtransitions into the ventral gripping surface 414. The circular openings434 of the walls 420, 422 are laterally aligned, as are two other pairsof circular openings 440, 442 extending through the walls in themedial-to-lateral direction. Both paired openings 440, 442 are smallerin diameter than the distal openings 434 and each is adapted to receivea pin 444 in order to repositionably mount the drive link 402 to thehandle 400. While only one of the paired openings-440, 442 will beoccupied by the pin 444, the other paired opening unoccupied may be useddepending upon the spring rate of the return spring 404 and the device(e.g., clip deployment device 118) comprising the end effector 118.

An exemplary drive link 402 comprises a U-shaped, longitudinallyextending plate sized to fit between the walls 420, 422 of the handle400. A distal end of the plate 402 includes the U-shaped bend and a pairof through openings (extending in a medial-to-lateral direction) thatreceive the pin 444. A proximal end of the plate 402 includes respectivelegs in parallel to one another and each having a through opening. Eachof the legs of the plate 402 is biased by the coiled return spring 404,which contacts the rounded end of each leg. In this exemplaryembodiment, the return spring 404 is not rigidly coupled to the drivelink 402, but rather is biased against the drive link and retained inposition by the bias of the return spring itself pushing againstrespective stiffening ribs of the housings 130, 132 and the proximalends of the plate 402. The through openings in the legs receive a secondpin 450, which is also concurrently received within the cavity 390 ofthe oblong projection 388 and within the cavity 316 of the oblongprojection 314, that couples the drive link 402 to the draw plate 406.

The draw plate 406 comprises a substantially straight and flat substratehaving three openings 460, 462, 464 that extend in the medial-to-lateraldirection. The first opening 460 receives the second pin 450 to mountthe drive link to the draw plate 406. The second opening 462 comprises arectangular opening with rounded corners, while the third opening 464comprises a smaller rectangular opening with rounded corners having aproximal-to-distal dimension that is less than the dorsal-to-ventraldimension. A strip of the draw plate 406 interposes the openings 462,464 and is deformed to create a lateral half loop 468 concave laterallyand convex medially. A second strip of the draw plate 406 at the distalend is also deformed to create a medial half loop 470 convex laterallyand concave medially. It should be noted that the lateral half loop 468is deeper than the medial half loop 470 because the lateral half loop468 is sized to accommodate a sleeve 474 that circumscribes a proximalportion of the draw wire 408. This sleeve 474 is not readilyrepositionable longitudinally along the draw wire 408. Accordingly,repositioning of the sleeve 474 while the draw wire 408 is in tensioncorrespondingly causes the draw wire to be repositioned.

The repositionable handle 400 is adapted to be grasped by a user andrepositioned from a retained position to a free position. In theretained position (see FIG. 26 ), the loop 428 of the handle 400 engagesthe detent 326 of the right side housing 130 to retain the handleadjacent to the housings 130, 132. When a user desires to disengage thehandle 400 from the detent 326, the user laterally slides the handleaway from the detent and out of engagement with the detent. Thereafter,the bias of the spring 404 is operative to push against the drive link402, which itself pushes against the handle 400 to force the handle awayfrom the housings 130, 132. At the same time, the draw plate 406 is alsorepositioned. When the handle 400 engages the detent 326, the draw plateis fully retracted in a proximal-most position. As will be discussed inmore detail hereafter, the proximal-most position of the draw plate 406results in the draw wire 408, which is also mounted to the pull link764, being pulled proximally to open the occlusion clip 1160.Conversely, when the handle 400 disengages the detent 326 and is movedaway from the housings 130, 132, the draw plate is repositioned in adistal direction. Eventually, if the handle 400 is repositioned to themaximum travel away from the housings 130, 132, the draw plate 406 ispositioned in a distal-most position. As will be discussed in moredetail hereafter, the distal-most position of the draw plate 406 resultsin the draw wire 408 repositioned distally in order to close theocclusion clip 1160.

Referring to FIGS. 2-4 , the controller 110 also includes a removablestem 490 that is seated within the proximal port 300 of the housings130, 132. The removable stem 490 is coupled to one or more clip releasewires 492 (in this case, two clip release wires) that act to disconnectan occlusion clip from the clip deployment device 118. In this manner,the stem may be removed from the proximal end of the controller 110,thereby drawing the release wire(s) proximally and disconnecting theocclusion clip from the clip deployment device 118. In this exemplaryembodiment, the stem 490 is secured within the proximal port 300 via afriction fit that may be overcome by the user applying pressure to thestem to move it proximally with respect to the controller 110. But it isalso within the scope of the disclosure to use detents or otheraffirmative release mechanisms to release the stem 490 from thecontroller 110.

Referencing back to FIGS. 2-32 , assembly of the controller 110 includesmounting the wheels 136, 138 to one another so that the interior faces146 of the wheels sandwich the link plates 180 therebetween. A detaileddiscussion of assembly of the wheels 136, 138 and link plates 180 hasalready been provided and will not be repeated for purpose of brevity.Thereafter, the wheels 136, 138 are oriented so that the axles 158 facein opposite directions and are received respectively within thecylindrical projection 380 of the left side housing 132 and within thecircular bearing surface 242 of the right side housing 130. Likewise,the drive link 402 is mounted to the right and left side housings 130,132 by way of the pin 450 concurrently received within the cavities 316,390 of the oblong projections 314, 388. In exemplary form, the drivelink 402 and right side housing 130 sandwich the draw plate 406therebetween. At the same time, the drive link 402 is mounted to thehandle 400, while the circular opening 434 of the handle receives acylinder 304 of the right side housing 130 in order to rotationallymount the handle to the housing. Moreover, the spring 404 is insetwithin the right side housing 130 so that the spring interposes theproximal stiffening rib 308 and the drive link 402. Finally, theremovable stem 490 is inserted between the housings 130, 132 andthereafter, the housings 130, 132 are mounted to one another to closethe controller. At this time, the draw wire 408, the clip release wires492, the connection wires 194, and the connection wire 261 all extendthrough the distal end 262 of the housings 130, 132.

Referring to FIGS. 20 and 30-32 , the controller 110 is mounted to asemi-rigid conduit 112 that is relatively linear and has a relativelyconstant circular cross section. In this exemplary embodiment, theconduit 112 is fabricated from stainless steel and includes a proximalcircular opening and a distal circular opening. The proximal circularopening provides access between the interior of the conduit 112 and theinterior of the controller 110. More specifically, the hollow interiorof the conduit 112 accommodates throughput of the draw wire 408, theclip release wires 492, the connection wires 194, and the connectionwire 261. The conduit 112 includes a proximal section having a pair ofrectangular, arcuate cut-outs 500. These cutouts 500 provide respectiveopenings for the detents 272 of the adapter 270 to occupy and mount theconduit 112 to the housings 130, 132.

In addition, as shown in FIG. 33 , the semi-rigid conduit 112 may berelatively linear but include two additional orifices 504, 506 thataccommodate a separate conduit 508 adapted to provide a separate avenuefor an exploratory tool 510. Exemplary exploratory tools for use withthe instant semi-rigid conduit include, without limitation, forceps,ablation rails, jaws, linear cutters, ablation pens, ablation clamps,illuminated dissectors, and non-illuminated dissectors. The exemplaryexploratory tool 510 may be used in combination with the end effector,which is manipulated by the repositionable mechanism 116.

Referring to FIGS. 34-38 , a distal portion of the exemplaryrepositionable mechanism 116 comprises a clevis 514 comprising ventraland dorsal clevis housings 516, 518. Each housing 516, 518 is a mirrorimage of the other and includes a convex, semi-cylindrical proximalsection 522 having a partially enclosed semicircular proximal end 524except for a notch 526. Extending longitudinally in a distal direction,the exterior surface of the semi-cylindrical proximal section 522includes a pair of through holes 530 extending into the interior of thehousing that are generally longitudinally aligned and positioned to liealong the apex of the cylindrical proximal section 522. Extendinglongitudinally in a distal direction beyond the through holes 530 is asemi-cylindrical collar 532 operative to increase the diameter of thehousing 516, 518 in comparison to the cylindrical proximal section 522that has a generally constant diameter. Extending distally from thecollar 532 is an overhang 536. The overhang 536 includes a generallyplanar exterior surface 538 that transitions into a sloped perimetersurface 540 embodying parallel sides with a rounded proximal end 542.The perimeter surface adjoins a substantially planar interior surface544 that is substantially in parallel with the planar exterior surface538. The interior surface 544 includes a circular depression 546 andincludes a circular circumferential surface 548 that extends between theinterior surface and a bottom, planar surface 550 of the depression. Theinterior surface also includes a portion of a rectangular depression 552that continues distally into a concave, semi-cylindrical interiorsurface 554 of the collar 532. It should be noted that thesemi-cylindrical interior surface 554 of the collar 532 takes on thesame dimensions as the semi-cylindrical interior surface of thecylindrical proximal section 522. But the semi-cylindrical interiorsurface 554 of the cylindrical proximal section 522 includes a distalrib 558 having generally the same shape as the partially enclosedsemicircular distal end 524. Similar to the semicircular distal end 524,the distal rib 558 also includes a notch 560 that is longitudinallyaligned with the other notch 526 so that the notches have generally thesame dimensions. When the housings 516, 518 are brought together, thedistal ribs 558 are aligned over one another so that the notches 560,526 cooperate to provide a pair of through openings. At the same time,the distal ends 524 of the housings are also aligned to create aninternal cavity that houses a bias spring 564 and a tooth receiver 566as part of the clevis 514.

Referring to FIGS. 36, 37, and 39-41 , the tooth receiver 566 includes aproximal cylindrical portion 568 having a uniform circular cross-sectionand extending substantially linearly. The uniform circular cross-sectionis sized to be received within the bias spring 564 upon assembly. Theproximal cylindrical portion 568 is hollow and includes a circularproximal end wall 570 having a pair of circular openings 572 eachadapted to accommodate throughput of the connection wires 194. A larger,oblong opening 574 interposes the circular openings 572 and is adaptedto accommodate throughput of the draw wire 408 and the clip releasewires 492. Extending distally from the cylindrical portion 568 is atooth receiving head 576 having medial M and lateral L sections thatextend medially and laterally from the cylindrical portion. Interposingthe medial and lateral sections is a cylindrical cavity 577 aligned withthe hollow cavity of the proximal cylindrical portion 568. Each sectionof the tooth receiving head 576 includes a generally rectangularcross-section, but for a series of distal teeth 578. Specifically, theteeth 578 have a sawtooth pattern and are formed to extend in themedial-to-lateral direction (perpendicular to a longitudinal axisextending through the cylindrical portion 568). In this exemplaryembodiment, the teeth 578 are sized to receive respective teeth 580 froma pair of toothed plates 582.

Referring to FIGS. 42-44 , the toothed plates 582 are also part of theclevis 514 and each toothed plate 582 comprises a circular, generallyflat plate. Approximately two hundred and twenty-five degrees of theplate has a circular circumferential surface 584. But the remaining onehundred and thirty-five degrees of the circumferential surface is formedto include a series of teeth 580. As discussed above, the teeth 580 aresized to be received in between the teeth 578 of the tooth receiver 566.Centered within the middle of each toothed plate 582 is a throughopening 586 delineated by parallel, linear sides 588 and arcuate ends590. These through openings 586 are adapted to receive a respectivepelvis half 594 in order to allow or limit lateral movement of thepelvis half.

Referencing back to FIGS. 35-37 , assembling the clevis 514 includesinserting the proximal cylindrical portion 568 of the tooth receiver 566into the cylindrical cavity outlined by the spiral shape of the biasspring 564. Assembling the clevis 514 also includes aligning the ventraland dorsal clevis housings 516, 518 so that the edges where the exteriorand interior surfaces meet match up and overlie each other. The edgesmay be welded or adhered together using conventional techniques. Theresulting structure from assembly of the housings 516, 518 creates adistal cylindrical cavity 598 and a proximal cylindrical cavity 600 thatare interposed by a circular wall having a through opening. As discussedpreviously, the circular wall is formed by joining the distal ribs 558of the housings 516, 518, while the opening is formed by joining thenotches 560. The distal cylindrical cavity 598 is sized to accommodatethe tooth receiver 566 inserted into the bias spring 564 so that the endof the bias spring opposite the tooth receiver contacts the circularwall to provide a stop against which the spring may be compressed. Atthe same time, distal end 524 is closed off except for an opening formedby the adjoined notches 526. As mentioned above, the connection wire 261is operatively coupled to the lever 236. This wire 261 also extendsthrough the semi-rigid conduit 112 and through the openings untilreaching the toothed receiver 566, where the wire is mounted to thetoothed receiver in order to facilitate repositioning of the toothedreceiver.

Referring to FIGS. 35-48 , the clevis 514 is coupled to a universaljoint 610. This universal joint 610 comprises a first pelvis half 594coupled to a second pelvis half 596. In order to provide lateralrepositioning, the pelvis halves 594, 596 are coupled to the clevis 514.In particular, the pelvis halves 594, 596 are identical to one anotherand, as such, a detailed explanation of only one of the pelvis halves isprovided in furtherance of brevity.

Each pelvis half 594, 596 includes a distal paddle 624 having asubstantially planar interior surface 626 that circles an upstanding rim628. An opening 630 extends through the rim 628 and through the paddle624, but is partially covered by an exterior convex cap 634 that isintegrally formed with the paddle. The cap 634 includes a V-shapedgroove 636 that extends into the opening 630 on one side, and a channel638 that extends into the opening from the opposite side. The channel638 extends proximally beyond the cap 634 and takes on an arcuate pathto partially wrap around a proximal end 640 of the pelvis half and endsproximate an integrated platform 642 having a circular profile. Asemi-circular interior surface 646 of the platform 642 is substantiallyplanar and includes a radial groove 648 with arcuate sidewalls and arounded end that extends to the center of the platform. The arcuatesidewalls operate to increase the width of the groove 648 as thedistance from the interior surface 646 increases. The radial groove 648also extends outward through a circular circumferential surface 650. Thecircumferential surface 650 defines the outer bounds of a ring-shaped,planar outer surface 652 that circumscribes an upstanding projection656. It is this upstanding projection 656 that extends through theopening 586 of a corresponding toothed plate 582 to mount the tootedplate to the yoke half 620 (see FIG. 42 ). In exemplary form, theupstanding projection 656 extends perpendicularly away from thering-shaped surface 652 and includes a pair of parallel straight sides658 that are interposed by a pair of arcuate sides 660 that collectivelydefine a plateau top 662.

In exemplary form, the distal paddle 624 includes a circular 664circumferential surface connecting to a neck 666 in order to connect thedistal paddle 624 to the integrated platform 642. The neck 666 alsoincludes an arcuate wall 668 adapted to match the contour of thecircular circumferential surface 650 of an opposing pelvis half 594,596. The neck 666 further includes a centered block 672 having a planarsurface 674 in parallel with the interior surface 646 of the platform642. This planar surface 674 is partially has a raised peninsula 678having arcuate sidewalls and an exposed rounded end. The arcuatesidewalls operate to decrease the width of the peninsula 678 as thedistance from the planar surface 674 increases. As will be discussed inmore detail hereafter, the dimensions of the peninsula 678 are generallythe same as the dimensions of the radial groove 648 so that a peninsulaof a first pelvis half 594, 596 is received within a radial groove of asecond pelvis half in order to align the pelvis halves when assembled.The block 672 also includes a portion of the channel 638 on one side,while it also includes a channel 682 having a semicircular cross sectionand extending substantially in a straight line, except for a proximalslope. The channel 682 is generally centered and extends radially towardthe interior surface 626 of the distal paddle 624. In exemplary form,the linear channel 682 interposes the peninsula 678 and the radialgroove 648, which are generally parallel to one another and in ahorizontally offset position.

Referring back to FIGS. 42, 43, and 45-48 , assembly of the universaljoint 610 includes orienting the pelvis halves 594, 596 so that theinterior surfaces 626 of the paddles 624 face one another. Likewise, thenecks 666 of the pelvis halves 594, 596 are oriented adjacent oneanother so that the peninsula 678 of the first pelvis half 594 isreceived within the radial groove 648 of the second pelvis half 596 sothe interior surface 646 of the platform 642 of the second pelvis halfcontacts the planar surface of the first pelvis half. In thisorientation, the pelvis halves 594, 596 are moved against one another(see FIG. 46 ) to define a circumferentially bounded through opening688. After the pelvis halves 594, 596 have been mounted to one anotherin the foregoing orientation, respective toothed plates 582 are mountedto each of the pelvis halves. In exemplary form, the each toothed plate582 is oriented so that the opening 586 is aligned with the upstandingprojection 656. Specifically, the parallel sides 658 of the upstandingprojection 656 are aligned and inset with respect to the parallel sides588 defining the opening 586, while the arcuate sides 660 of theupstanding projection are aligned and inset with respect to the arcuateends 590 defining the opening. Thereafter, the ventral and dorsal clevishousings 516, 518 are repositioned to sandwich the pelvis halves 594,596. Specifically, the circular depression 546 of each housing receivesa respective upstanding projection 656 of a pelvis half 594, 596. Thecircular boundary of the depression 546 is slightly larger in diameterthan the distance between the arcuate sides 660 of the projections,thereby allowing the projections to rotate within the depressions. Itshould be noted that the arc of the sides 660 is more pronounced thanthat of the wall 548 defining the projection, but no so much thatconsiderably play is present. At the same time as the pelvis halves 594,596 are sandwiched by the ventral and dorsal clevis housings, bothtoothed plates 582 are oriented so that at least one tooth 580 isreceived within a gap between the teeth 578 of the tooth receiver 566.When the teeth 580 of the toothed plates 582 engage the teeth 578 of thetooth receiver 566, rotational motion (angular changes in the horizontalplane) of the pelvis halves 594, 596 with respect to the ventral anddorsal clevis housings 516, 518 is inhibited. Conversely, when the teeth580 of the toothed plates 582 are not engaged with the teeth 578 of thetooth receiver 566, the pelvis halves 594, 596 are able to rotate withrespect to the ventral and dorsal clevis housings 516, 518. The defaultposition of the tooth receiver 566 creates engagement between therespective teeth 578, 580 based upon the bias exerted upon the toothreceiver by the spring 564. But this bias may be overcome by pulling thetooth receiver 566 proximally using the connection wire 261 concurrentlycoupled to the tooth receiver and the repositionable lever 236. Inparticular, to lock the angular position of the pelvis halves 594, 596with respect to the ventral and dorsal clevis housings 516, 518, thelever 236 is rotated distally to allow the bias of the spring 564 topush the tooth receiver 566 into engagement with the toothed plates 582.To unlock the pelvis halves 594, 596 with respect to the ventral anddorsal clevis housings 516, 518, the lever 236 is rotated proximally toovercome the bias of the spring 564, thereby compressing the spring andpulling the tooth receiver 566 out of engagement with the toothed plates582. When this occurs, the pelvis halves 594, 596 as a whole are able tochange their angular, horizontal orientation with respect to the ventraland dorsal clevis housings 516, 518 and have a range of angularadjustment of 160 degrees. This angular adjustment and correspondingangular orientation are carried over from the pelvis halves 594, 596 toa yoke 614.

In exemplary form, the clevis 514 (housings 516, 518, spring 564, andtooth receiver 566), the toothed plates 582, and the pelvis halves 594,596 cooperate to form the distal part of the passive mechanism. Thispassive mechanism allows or inhibits yaw (i.e., side to side) of the endeffector 118 depending upon whether the tooth receiver 566 is distallybiased by the spring 564 into engagement with the toothed plates 582.Because the tooth receiver 566 is either engaged or disengaged withrespect to the toothed plates 582, the mechanism is considered passive.In other words, unlike the active mechanism previously discussed, thispassive mechanism does not operate to reposition the end effector sideto side. Rather, this passive mechanism provide full freedom to movelaterally within the range of motion between the clevis 514 and pelvishalves 594, 596 when the tooth receiver 566 is not engaging the toothedplates 582. In exemplary form, it is anticipated that a roboticinstrument (not shown) or an anatomical feature (i.e., the heart itself)in cooperation with pressure applied to the distal end of the semi-rigidconduit 112 would reposition the end effector laterally (such as shownin exemplary form by the three positions depicted in FIG. 17B) once thecontroller 110 is manipulated (specifically, the lever 236) to disengagethe tooth receiver 566 from the toothed plates 582. As long as the toothreceiver 566 is disengaged from the toothed plates 582, the end effector118 may be repositioned (i.e., is not laterally locked in place). Butwhen the lever 236 is actuated so that the spring 564 force is dominantand the tooth receiver 566 engages the toothed plates 582, lateralrepositioning of the end effector 118 is inhibited.

Referring to FIGS. 49-52 , the yoke 614 comprises a cylindrical proximalend 690 integrally coupled to a floor 692 and a roof 694 that areidentically shaped. More specifically, as will be discussed in moredetail hereafter, the cylindrical proximal end 690 includes a throughcavity 696 that extends into an open space 698 between the floor 692 anda roof 694 in order to accommodate certain parts of the repositionablemechanism 116.

In exemplary form, the cylindrical proximal end 690 includes acircumferential groove 702 operative to bisect the cylindrical proximalend into a pair of discs 704. Each disc 704 is a mirror image of theother and includes a rounded circumferential surface 706 having agenerally constant width and defining the outer bounds of asubstantially planar lateral surface 708 that is generally perpendicularwith respect to the circumferential surface. This lateral surface 708 isgenerally ring-shaped to define a cylindrical depression 710 that doesnot extend entirely through the disc 704 and is equidistantly spacedwith respect to the edge of the circumferential surface 706. Inexemplary form, the cylindrical depression 710 is defined by a topbeveled ring 714, followed by a constant diameter ring 716, followed bya second beveled ring 718 that adjoins a substantially planar bottomsurface 720 in parallel with the lateral surface 708.

The circumferential groove 702 between the discs 704 extends in asemicircular path and intersects a through hole 722 extending throughthe floor 692 and roof 694. Opposite the through hole 722, at theproximal end of the groove 702, a V-shaped opening is formed that ispart of the through cavity 696, where the distal tip of the opening isdefined by a rectangular boundary 724, which is adjacent to a circularwall 726 that defines a cylindrical portion of the through cavity.Ventral and dorsal sections of the groove 702 receive a respectiveconnection wire 194, where each connection wire is threaded within aportion of the groove so that pulling on a first of the connection wirescauses the yoke 614 to move upward (i.e, ventrally), while pulling onthe second of the connection wires causes the yoke to move downward(i.e, dorsally). More specifically, the connection wires 194 arepartially looped around the yoke 614 by lying within a portion of thegroove 702 and terminate in a cavity where the connection wire 194 issecured in place.

Extending distally from the discs 704 are the roof 694 and floor 692.Both the roof 694 and floor 692 comprise a rounded overhang having arelatively planar exterior surface 732 that transitions into a slopedcircumferential surface 734, that itself transitions into a verticalcircumferential surface 736 that is perpendicular to the exteriorsurface. It should be noted that the vertical thickness of the roof 694is greater than that of the floor 692, but other than this thicknessdifference the roof and floor are identical. The verticalcircumferential surface 736 defines the outer boundary for themulti-tiered interior surface 738. In particular, the interior surface738 is partially defined by a raised plateau 740 having a relativelyplanar end surface 742 adjoining a relatively planar vertical sidewall744 that is offset from a midline of the yoke 614. Adjoining thesidewall 744 is a relatively planar horizontal wall 746, which is itselfadjoined by a block U-shaped groove 748. The plateau 740, sidewall 744,horizontal wall 746, and U-shaped groove 748 cooperate to create astair-step cross-section. But the U-shaped groove does not extenddistally as far as the sidewall 744 and the horizontal wall 746 becausethe U-shaped groove terminates in a proximal wall 752 that is distal tothe ends of the sidewall and horizontal wall that terminate at a backwall 754. Proximate the back wall 754, both the roof 694 and floor 692include a pair of vertical through openings that are aligned with theircounterpart through openings and receive a pair of dowels 758. Asdiscussed in more detail hereafter, the dowels are concurrently mountedto the roof 694 and floor 692, as well as to a repositionable jawassembly 760.

Referencing FIGS. 49, 50, and 52-54 , the repositionable jaw assembly760 includes a pull link 764 operatively coupled to the connection wire194 at its proximal end and concurrently coupled to right and left linkplates 766, 768 at its distal end. In this exemplary embodiment, thepull link 764 comprises a hollow cylinder 770 mounted to a miniatureclevis 772. In particular, the hollow cylinder 770 is mounted to extendperpendicularly away from the base of the clevis 772 and is adapted toreceive the connection wire 194 therein. More specifically, theconnection wire 194 is glued to the interior of the hollow cylinder 770so that tensioning of the connection wire in the proximal direction isoperative to reposition the pull link 764 proximally. This proximalrepositioning is also operative to reposition the ends of the linkplates 766, 768 mounted to the clevis 772. In exemplary form, the clevis772 includes a pair of spaced apart, upstanding arms 774 having agenerally constant width and height along their longitudinal length.Each upstanding arm 774 terminates at a hollow ring 776 having a heightgenerally the same as that of the upstanding arms, but a width that isgreater than the upstanding arms. The width of both rings 776 isgenerally the same and is sized to fit between respective vertical walls744 of the floor 692 and roof 694 in order to ensure that motion of theclevis 772 with respect to the yoke 614 is linear.

Referring to FIGS. 55-57 , the yoke 614 also has mounted to it a pair ofright and left link clips 780, 782 that are concurrently mounted to thelink plates 766, 768. In exemplary from, the right and left link clips780, 782 are mirror images of one another and each include a proximalthrough hole 786 that receives a dowel 758 of the yoke 614 to pivotallymount the right and left link clips to the yoke. At the same time, theright and left link clips 780, 782 include a second through hole 788,distal to the proximal hole 786, that receives a dowel 790 that iscurrently received through an opening 792 at the ends of the link plates766, 768. The openings 792 at the ends of the link plates 766, 768 arelarger in diameter than the diameter of the dowel 790, so that the linkplates are pivotally repositionable around the dowel. Conversely, thesecond through hole 788 has generally the same diameter as the diameterof the dowel 790, thereby securing the dowel within the second throughhole via a friction fit. Opposite the ends of the of the link plates766, 768 is an internal through hole 794 having a diameter larger than adowel 796 that is frictionally received within the rings 776 of theclevis 772. In this manner, the link plates 766, 768 are pivotallyrepositionable with respect to the dowel 796 and clevis 772. At a distalend of each right and left link clip 780, 782 is a rounded, flat head798 that circumscribes a distal opening 800 having a three-quarter moonshape. In particular, the distal head 798 is sized so that the width ofthe head is greater than the width of the remainder of the link clips780, 782. More specifically, the distal head 798 is rounded to extendtoward the interior of the repositionable jaw assembly 760. As will bediscussed in more detail hereafter, the rounded profile of the distalhead matches a cylindrical profile of a corresponding jaw 806, 808.

When assembled, the hollowed rings 776 of the clevis 772 are interposedby the ends of the link plates 766, 768. The opposite ends of the linkplates 766, 768 interpose respective right and left link clips 780, 782.Accordingly, the left link clips 782 directly overly one another and arespaced apart from one another by the thickness of the left link plate768 and an associated gap operative to provide movement between the leftlink plate and the left link clips. Likewise, the right link clips 780directly overly one another and are spaced apart from one another by thethickness of the right link plate 766 and an associated gap operative toprovide movement between the right link plate and the right link clips.At the same time, the distance between the roof 694 and floor 692,proximate the plateau 740 on the right side is slightly larger than thecumulative thicknesses of the right link clips 780 and right link plate766. Similarly, the distance between the roof 694 and floor 692,proximate the plateau 740 on the left side is slightly larger than thecumulative thicknesses of the left link clips 782 and left link plate768. Upon assembly, the link plates 766, 768 are rotationallyrepositionable with respect to the clevis 772 and the right and leftlink clips 780, 782, while the right and left link clips arerotationally repositionable with respect to the link plates and withrespect to the dowels 758 of the yoke 614. As will be discussed in moredetail hereafter, retraction of the clevis 772 proximally (see FIG. 49 )within the yoke 614 is operative to widen the gap between the roundedends 798 of the right and left link clips 780, 782. Conversely,repositioning the clevis 772 distally with respect to the yoke 614 isoperative to decrease the gap between the rounded ends 798 of the rightand left link clips 780, 782. In this manner, the repositioning of theclevis 772 is indirectly operative to reposition the right and left jaws806, 808.

Referencing FIGS. 49, 58, and 59 , the right and left jaws 806, 808 aremirror images of one another and are respectively mounted to the rightand left link clips 780, 782. Accordingly, in furtherance of brevity,only the left side jaw will be shown and discussed with respect to FIGS.58 and 59 . Each jaw 806, 808 includes a proximal end clevis 810 thatcomprises a top rounded shelf 814 that is spaced apart from a bottomrounded shelf 816. Each shelf 812, 814 includes a through opening 818operative to receive a half-moon shaped cylindrical dowel 820. Thisdowel 820, while being concurrently received within the through openings818 of the shelves 812, 814, is also received within the distal opening800 of a respective pair of the link clips 780, 782. In exemplary form,the dowel 820 is frictionally fit within the through openings 818 sothat the dowel is not rotationally repositionable within the throughopening. In contrast, the half-moon shape of the dowel 820 does notoccupy all of the area of the three-quarter moon shape of the distalopenings 800. In this manner, there is play between the walls definingthe distal opening and the dowel 820 so that the dowel is rotationallyrepositionable with respect to the respective link clips 780, 782. Inorder to further stabilize the connection between the respective jaw806, 808 and the respective link clips 780, 782, each jaw includes aprojection 824 that extends proximally from a vertical wall 826 thatconnects the shelves 812, 814 at their respective distal ends. Thethickness of this projection 824 approximates the gap between therespective overlying link clips 780, 782 in order to inhibit the distalends 798 of the link clips from compressing against one another. Rather,because of the projection 824, compression is reduced and to the extentcompression occurs, the overlying link clips 780, 782 compress againstthe projection instead of against one another.

Extending distally from the proximal end clevis 810 is an elongatedguide 830 having a convex exterior longitudinal profile and a concaveinterior longitudinal profile. The elongated guide 830 has a dominantlongitudinal dimension and a vertical dimension that approximates andextends beyond the thickness of a clamping portion 1162, 1164 (see FIG.75 ). In exemplary form, the distal end 832 of the guide 830 is rounded.Interposing the distal end 832 and the proximal end clevis 810 is a pairof lateral through holes 836, 838 that receive sutures 840 in order tomount the jaw 806, 808 to a respective clamping portion 1162, 1164. Anexterior side 844 of the guide 830 includes a longitudinal channel 846that extends from the distal end 832, crossing each of the through holes836, 838, proximally through the vertical wall 826 and ending adjacentthe projection 824. This channel 846 receives a respective clip releasewire 492 that is coupled to the removable stem 490 of the controller110. In exemplary form, the suture 840 is concurrently wrapped around(in a loop) the clip release wire 492 and a respective clip segment. Inthis manner, when the clip is ready to be deployed, the removable stem490 is proximally repositioned with respect to the remainder of thecontroller 110, thereby pulling the clip release wires 492 proximally.Initially, the end of the clip release wires 492 passes completelythrough the distal suture 840, followed by passing completely throughthe proximal suture 840, thereby releasing the clip from the guides 830and the remainder of the laparoscopic device 100.

Referring to FIGS. 44, 60, and 61 , the repositionable jaw assembly 760is operative to be linearly aligned to fit through a trocar foranatomical deployment. Initially, as shown in FIGS. 60 and 61 , therepositionable jaw assembly 760 is linearly aligned and in a compact,widthwise position. In this position, a first face 850 of each dowel 820of both jaws 806, 808 contacts a first face 852 defining a portion ofthe three-quarter shaped moon opening 800.

Referring to FIGS. 44, and 62-66 , in order to open the jaws 806, 808,the pull link 764 is pulled proximally via the connection wire 194. Theproximal movement of the pull link 764 causes the ends of the right andleft link plates 766, 768 coupled to the pull link to be repositionedproximally by pivoting around the dowel 796 extending through the pulllink. Because the opposing ends of the link plates 766, 768 arepivotally coupled to the right and left link clips 780, 782 via thedowels 790, the motion of the pull link is operative to spread thedistal ends of the link clips away from one another. As discussedpreviously, the three-quarter moon shaped opening 800 allows limitedpivotal motion of the dowel 820 of a respective jaw 806, 808 withrespect to the link clips 780, 782. In this manner, the pivotal motionbetween the link clips 780, 782 and the jaws 806, 808 causes the distalends of the jaws 806, 808 to initially move closer to one another, whilethe proximal ends of the jaws move farther away from one another asshown in FIG. 62 . While the link plates 766, 768 pivot with respect tothe link clips 780, 782, the link clips are also operative to pivot withrespect to the jaws 806, 808 evidenced by the first face 850 of thedowel 820 moving farther away from the first face 852 of the link clipsas shown in FIG. 63 . Continued proximal movement of the pull link 764results in the distal ends of the link clips 780, 782 being moved evenfarther from one another as shown in FIG. 64 . When in this position, asshown in FIG. 65 , further pivoting action between the jaws 806, 808 andthe link clips 780, 782 is inhibited by the second face 854 of the dowel820 contacting the second face 856 of the link clips that defines aportion of the three-quarter moon shaped opening 800. In other words,the faces 852, 856 of the link clips 780, 782 provide range of motionboundaries for the dowel 820 to pivot between. When the second facescontact one another, the maximum angle is reached between the link clips780, 782 and the jaws 806, 808. Thereafter, continued proximal movementof the pull link 764 to a maximum proximal end point (i.e., a travellimit) causes the distal ends of the link clips 780, 782 to reach amaximum spacing, which corresponds to the distal ends of the jaws 806,808 moving apart from one another as shown in FIG. 66 . In exemplaryform, when the pull link 764 reaches the maximum proximal end point, thejaws 806, 808 arrive at a parallel position. This parallel positionwould not otherwise be obtainable without some pivotal motion betweenthe jaws 806, 808 and the link clips 780, 782. As shown in FIG. 67 ,without the pivoting action between the link clips 780, 782 and the jaws806, 808, the jaws would take on the angular orientation of the linkclips and never arrive at a parallel position when spaced apart from oneanother when the pull link 764 reaches its proximal endpoint.

FIGS. 68 and 70 show one embodiment of a left atrial appendage occlusionclamp 1110 in an open position with spaced apart rigid clamping portions1102, 1104 and resilient or elastic urging members 1106, 1108 atopposite ends of each clamping portion 1102, 1104. Clamping portions1102, 1104 may be tubular, and both clamping portions 1102, 1104 may beat least substantially parallel to each other when arrest, i.e., whenthey are not being used to clamp tissue. Clamping portions 1102, 1104may also be of substantially equal length or of different length, andeach may be of larger outer diameter than the wire that may be used toform each of the urging members 1106, 1108. In this regard, the wireforming urging members 1106, 1108 can extend through the hollowinteriors of the clamping portions 1102, 1104. In this illustrativeexample, the urging members 1106, 1108 are each shaped as a loop. Theplanes defined by the looped configuration of each of the urging members1106, 1108 may be substantially parallel to each other and, in turn,substantially perpendicular to each of the clamping portions 1102, 1104.Of course, other angular orientations are possible as well,

FIGS. 69 and 71 show the same clamp 1110 of FIGS. 68 and 70 with theclamping portions 1102, 1104 in their normally biased togetherpositions. Contact between the clamping portions 1102, 1104 may occurinitially along their entire parallel lengths as shown. Of course, whenclamping portions 1102, 1104 are covered in fabric or other material aslater described, contact may occur between the fabric or other materialinstead. In FIGS. 68-71 , only the structure and relative positions ofthe rigid members 1102, 1104 and urging members 1106, 1108 are shown.The final assembly is depicted in FIGS. 72-74 which, although describinga slightly different embodiment, show the general steps in theconstruction of each embodiment. The clamping portions 1102, 1104 may bemade from rigid tubes 1112, 1114 of a rigid metal such as titaniumdisposed over a wire member 1116. In this embodiment, titanium is usedfor its compatibility with MRI imaging, its bio compatibility and itsgalvanic compatibility with the wire member 1116 when the wire member1116 is formed from superelastic materials such as a nickel titaniumalloy. This embodiment and the other embodiments disclosed herein mayuse a superelastic material such as a nickel titanium alloy to form theurging members 1106, 1108. Superelastic properties will allow thematerial to be greatly extended to open the clamping portions 1106, 1108of the clamp 1110 without permanently deforming the material. Thesesuperelastic materials can also be compatible with MRI imaging andeasily tolerated as an implant material in the body. The rigid tubularmembers 1112, 1114 of this embodiment are mechanically fastened to theunderlying wire member 1116 preferably by mechanically swaging thetitanium tubes 1112, 1114 to the wire members 1116. Although a single,continuous wire member is shown directed through both clamping portions1102, 1104 and urging members 1106, 1108, the clamp 1110 of thisembodiment may also be made with two or more wires, or with any othersuitable components.

As shown in FIG. 72 , in addition to being able to close on tissue oranatomical structure in a parallel fashion, the clamp 1110 can alsoapply force to the anatomical structure in a nonparallel clampingfashion. This allows the clamp 1110 to accommodate non-uniform tissuethickness over the length of the clamping portions 1102, 1104. Inaddition, with separate urging members 1106, 1108 at opposite ends ofthe clamping portions 1102, 1104 the nonparallel clamping can originatefrom either side of the clamp 1110. The non-parallel clamping feature ofthis embodiment allows the clamp 1110 to accommodate a wide range ofhollow anatomical structures with varying wall thicknesses throughoutits length and breadth. For example, some anatomical structures such asatrial appendages of the heart have internal structures calledtrabeculae, which are non-uniform and very often cause variablethicknesses across one or more of their dimensions. Nonuniform clamping,therefore, can be advantageous in this application for this reason orfor other reasons.

FIG. 73 shows an alternate embodiment of a clamp 1160 including twourging members 1166, 1168 shaped to resemble a letter “U” instead of themore circular loop configuration of the embodiment of FIGS. 68-71 . Asis the case with the first clamp 1110, the U-shaped urging members 1166,1168 of clamp 1160 may also lie in planes generally parallel to eachother and perpendicular to the axes of the clamping portions 1162, 1164.A potential use of the embodiment of FIG. 73 may lie in the lesser forceexerted by U-shape urging members 1166, 1168 on the clamping portions1162, 1164 with respect to the force exerted by the loop-shape urgingmembers 1106, 1108 of clamp 1110 in FIGS. 68-71 , making it moresuitable for clamping of anatomical structures not requiring arelatively high clamping force. The U-shape configuration of the urgingmembers 1166, 1168 generally requires less space in the directionperpendicular to the axes of the clamping portions 1162, 1164. FIG. 73shows a first stage of assembly of the clamp 1160, where the rigidtubular members 1163, 1165 are joined with the superelastic wire member1161. In this embodiment, mechanical swaging is used to join the tubularmembers 1163, 1165 to the wire 1161. However, adhesives or laser weldingor other methods of attachment could be easily used instead. Similarly,it will be appreciated that rigid tubular members 1163, 1165 may notnecessarily need to be bonded to wire member 1161 at all. One may rely,for example, on designing the rigid tubular members 1163, 1165 so thattheir inside diameters simply closely fit over the wire 1161. Inaddition, the rigid tubular members 1163, 1165 could take on manydifferent cross sectional shapes. Cross-sectional shapes such as ovals,triangles or rectangles with rounded edges could be preferable and mayeliminate the addition of the load spreading platens 1167, 1169 shown inFIG. 74 , as these alternate shapes may provide a larger area of contactagainst the anatomical structure to be engaged by the clamp 1150. Sincedifferent anatomical structures greatly vary from subject to subject, itis advantageous to have a manufacturing method in which the length 1171of the clamp 1160 can be easily varied. By cutting rigid members 1163,1165 to various different lengths, different size assemblies can beconfigured.

FIG. 74 shows the next step in the assembly of the clamp. Load spreadingplatens 1167, 1169 made of plastic or other biocompatible material suchas urethane, may be slipped over the titanium or other suitable materialtubing that forms rigid tubular members 1163, 1165, to provide aresilient surface 1173 to spread the load out onto a larger surfacearea, thereby preventing point source loading of the tissue which mightotherwise result in cutting of the tissue before it has had a chance tobecome internally fused. The platens 1167, 1169 can be assembled andapplied over the rigid tubular members 1163, 1165 prior to the swagingstep or platens 1167, 1169 can alternatively be manufactured in such away so as to have a longitudinal split which allows the material to beopened and forced onto the rigid tubular members 1163, 1165.

FIG. 75 shows the clamp 1160 after a fabric cover material 1174 made ofmaterial such as polyester has been sewn around the clamping portions1162, 1164 and urging members 1166, 1168. It will be appreciated thatthis material or any other similar materials may be used as a full orpartial covering in any of the disclosed embodiments. Such a material ispreferably suitable to engage the tissue of the anatomical structurebeing clamped as well as that of surrounding areas. Preferably, thematerial 1174 is circular warp knit fabric tube, with a diameter ofapproximately 4 to 5 mm and made from a combination of 4/100, 2/100 and1/100 textured polyester. The material 1174 may also be heat-treated tocause a velour effect. The fabric or other material 1174 is furthermoresewn or otherwise applied over the urging members 1166, 1168. Inaddition, fabric pieces 1177 may be attached at opposite respective endsof clamping portions 1162, 1164 to prevent any part of the engagedanatomical structure from escaping the annular occlusion area betweenthe clamping portions 1162, 1164. In other words, fabric pieces 1177 actas tissue blocking members or dams at opposite ends of the clamp. Thisor another tissue blocking feature may also be implemented into anyother embodiment. This is desirable as it minimizes the probability ofunintentionally leaving any part of the engaged anatomical structureunclamped. The material 1177, like material 1174, can also promotetissue in-growth.

Referring to FIGS. 76-82 , an alternate exemplary controller 1210 may beused in place of the foregoing controller 110 with the exemplarylaparoscopic device 100. Similar to the first controller 110, thisalternate exemplary controller 1210 may be coupled to the semi-rigidconduit 112 in order to manipulate a repositionable mechanism (notshown) operatively coupled to the end effector 118. But, as will bediscussed in more detail hereafter, this exemplary controller 1210incorporates a dual passive mechanism in order to control the pitch(i.e., up and down) and the yaw (i.e., side to side) of the endeffector. In exemplary form, unlike the first exemplary controller 110,this alternate exemplary controller 1210 does not includes an activemechanism to manipulate the pitch of the end effector 118, but insteadutilizes a passive system that is operative to lock in the end effectorin one of a predetermined number of pitch positions.

The controller 1210 comprises a right side housing 1230 and a left sidehousing 1232 that cooperatively define an internal cavity andcorresponding openings to accommodate throughput of certain controls. Afirst of these openings is a dorsal opening 1234 that accommodatesthroughput of a vertically repositionable button 1236. As will bediscussed in more detail hereafter, the repositionable button 1236 maybe manipulated vertically to lock and unlock the repositionablemechanism 116 in order to provide for or constrain lateral and verticaladjustability of the end effector 118.

The repositionable button 1236 comprises a proximal-to-distal arcuatetop 1238 that includes bumps and a proximal ridge to accommodate thethumb of a user being positioned on top of the button. Themedial-to-lateral width of the arcuate top 1238 is generally constantand overlaps a vertical, planar appendage 1242 that extends from theunderside of the arcuate top. This vertical appendage 1242 has arelatively constant and minimal medial-to-lateral dimension, butincludes a proximal-to-lateral dimension that tapers from a maximumwhere the appendage extends from the arcuate top, to a minimum where theappendage ends. At the end of the appendage 1242, a pair of toothreceivers 1246 extend outward in the medial and lateral directions fromopposing sides of the appendage. The tooth receivers 1246 each include aseries of longitudinal pyramidal shapes 1248 that are in parallel andradially arranged in order to define a series of correspondinglongitudinal pyramidal cavities 1250. At the medial end of the medialtooth receiver 1246 and at the lateral end of the lateral tooth receiver1246 is a cylindrical projection 1252 that is received withincorresponding vertical, oblong grooves 1254 on the interior of thehousings 1230, 1232. These grooves 1254 inhibit significantmedial-to-lateral and proximal-to-distal travel of the tooth receivers1246 as the tooth receivers are vertically repositioned. In other words,as the button 1236 is depressed vertically, the toothed receivers 1246are vertically repositioned in a corresponding vertical manner. In thisway, the movement of the toothed receivers 1246 is directly attributableto the movement of the button 1236 as the toothed receivers areindirectly mounted to the button via the appendage 1242.

The button 1236 is biased vertically to its highest vertical positionshown in FIG. 79 . To achieve this bias, the housings 1230, 1232includes parallel walls 1258 that cooperate to form medial-to-lateraltrench within which at least one spring 1260 is seated. The spring 1260is rated at a sufficient spring force to overcome the weight of thebutton 1236, appendage 1242, tooth receivers 1246, and cylindricalprojections 1252 to force the button to its highest vertical position.But the spring force is not so great that it requires too great a forcefrom a user's thumb to depress the button 1236 and overcome the bias ofthe spring 1260.

An axle 1264 extends in the medial-to-lateral direction within theinterior cavity cooperatively defined by the housings 1230, 1232. Thisaxle 1264 is cylindrical in shape and includes a constant longitudinaldiameter, thereby giving the axle a circular circumference. In exemplaryform, the medial and lateral ends of the axle 1264 are received withincorresponding cylindrical cavities (not shown) on the interior of thehousings. The depth of these cavities is not so great as to cover themajority of the axle 1264. The exposed cylindrical portion of the axle1264 is operative to receive a pair of toothed assemblies 1268, 1270that are interposed by the appendage 1242, which itself includes avertical, oblong orifice (not shown) to accommodate throughput of theaxle and vertical travel of the appendage with respect to the axle,which has a fixed orientation. In exemplary form, the toothed assemblies1268, 1270 includes a through cylindrical orifice 1272 allowing theassemblies to rotate on the outside of the axle.

Each of the toothed assemblies 1268, 1270 are identical to each other.Accordingly, a redundant description of the second toothed assembly hasbeen omitted in furtherance of brevity. The toothed assemblies 1268,1270 include a wheel 1276 having circumferentially distributed teeth1278 that are sized to engage a respective tooth receivers 1246 and bereceived within the longitudinal pyramidal cavities 1250 when the toothreceivers in a raised vertical position (see FIG. 79 ). The wheel 1276has a generally uniform width but for a pair of outgrowths 1280, 1282.The first outgrowth 1280 is generally centered radially with respect tothe wheel and partially defines the through orifice 1272 that receivesthe axle 1264. This first outgrowth 1280 is semicircular in shapeextends medially from the wheel 1276 and includes a corresponding topand bottom arcuate surfaces 1284, 1286 that are radially inset withrespect to the wheel. These arcuate surfaces 1284, 1286 act as cammingsurfaces for respective connection wires 1288, 1290 that extend from thesecond outgrowth 1282. The first outgrowth 1280 also includes a pair ofvertical flanges 1294 that extend from the arcuate surfaces 1284, 1286and cooperate with the circumferential ends of the wheels in order toprovide medial and lateral guides for the connection wires 1288, 1290 sothat the connection wires stay therebetween. The second outgrowth 1282is proximally oriented with respect to the first outgrowth 1280 andincludes a rectangular profile with a pair of L-shaped walls 1292 andfloor 1296 cooperating to define an internal cavity. An opening (notshown) extends through the floor and into the cavity. This openingreceives a fastener (such as a screw) 1300 around which the connectionwires 1288, 1290 are wound and secured in place. The fastener 1300 isalso recessed within the cavity so that the L-shaped walls 1292 extendlaterally beyond the end of the fastener. Accordingly, the connectionwires 1288, 1290 extending from the fastener are threaded through a gapbetween the L-shaped walls 1292, with one of the wires being threadedover the top arcuate surface 1284, while the second wire is threadedunder the bottom arcuate surface 1286. Thereafter, the wires 1288, 1290extend distally and taper to extend through a respective eyelet openingat the proximal end of the conduit 112.

Each of the toothed assemblies 1268, 1270 is independently rotatablyrepositionable with respect to one another. The first toothed assembly1268 is operative provide part of a passive repositionable mechanism inorder to control the pitch (i.e., up and down) of the end effector 118,while the second toothed assembly 1270 is operative to provide part of apassive repositionable mechanism in order to control the yaw (i.e., sideto side) of the end effector. In exemplary form, when the button 1236 isnot depressed, the spring 1260 is operative to bias the toothedreceivers 1246 into engagement with the teeth 1278 of the toothedassemblies 1268, 1270, thereby inhibiting rotation of the toothedassemblies around the axle 1264. When the tooth assemblies 1268, 1279are locked in position (see FIG. 79 ) the end effector 118 cannot berepositioned in the vertical direction (i.e., affecting pitch) or in themedial-to-lateral direction (i.e., affecting yaw). Thus, when the toothassemblies 1268, 1279 are locked in position (see FIG. 79 ), so too isthe end effector 118 locked in position.

In order to change the vertical or medial-to-lateral position of the endeffector 118, a user would depress the button 1236. By depressing thebutton 1236, the toothed receivers 1246 are operative to furthercompress the spring 1260 and disengage the toothed assemblies 1268,1270. More specifically, the longitudinal pyramidal shapes 1248 andcorresponding longitudinal pyramidal cavities 1250 no longer engage theteeth 1278 of the toothed assemblies 1268, 1270, thereby allowingrotation of the toothed assemblies around the axle 1264. By allowingfree rotation of the toothed assemblies 1268, 1270 around the axle 1264,the connection wires 1288, 1290 linking the end effector 118 and thetoothed assemblies may be repositioned, which allows the end effector tobe freely repositionable in the vertical direction (i.e., affectingpitch) and in the medial-to-lateral direction (i.e., affecting yaw).After the respective vertical and medial-to-lateral position of the endeffector 118 has been reached, the user would discontinue depressing thebutton 1236 to lock in the relative vertical and medial-to-lateralpositions. In order to lock in the positions, the spring 1260 forces thetoothed receivers 1246 upward and into engagement with the toothedassemblies 1268, 1270. Because the toothed assemblies 1268, 1270 includeteeth 1278 that engage the longitudinal pyramidal shapes 1248 of thetoothed receivers 1246, the spring 1260 will direct the toothedreceivers upward and cause the toothed assemblies to possibly rotateslightly about the axle 1264 so that the teeth are fully received withinthe longitudinal pyramidal cavities 1250. If the position of the endeffector 118 is such that the teeth 1278 are aligned with thelongitudinal pyramidal cavities 1250, then the vertical andmedial-to-lateral positions will be precisely maintained because of thetension on the connection wires 1288, 1290. But if the position of theend effector 118 is such that the teeth 1278 are slightly misalignedwith the longitudinal pyramidal cavities 1250, then the vertical andmedial-to-lateral positions will be changed as the toothed assemblies1268, 1270 rotate slightly about the axle 1264 so that the teeth arefully received within the longitudinal pyramidal cavities 1250. Afterthe teeth 1278 are aligned and received within the longitudinalpyramidal cavities 1250, the vertical and medial-to-lateral positionswill be precisely maintained because of the tension on the connectionwires 1288, 1290.

In order to maintain the orientation of the semi-rigid conduit (whichcarries the connection wires 1288, 1290) with respect to the housings1230, 1232, a distal portion of the right side housing 1230 includes apair of detents 1302 that engage the semi-rigid conduit 112. Thesedetents 1302 inhibit longitudinal movement of the conduit 112 withrespect to the controller 1210. Both detents 1302 extend in parallel toone another and extend from an interior circumferential surface of theright side housing 1230.

The right and left side housings 1230, 1232 cooperate to delineate ahandle mechanism port 1310 and a proximal port 1312 open to theinteriors of the respective housings. The handle mechanism port 1310accommodates throughput of a portion of a handle mechanism 1318 thatcomprises a repositionable handle 1320, a drive plate 1322, a returnspring 1324, and a wire retainer 1326. As will be discussed in moredetail hereafter, the wire retainer is concurrently coupled to a drawwire 1328 and the drive plate 1322 so that movement of the handle 1320is operative to open and close an occlusion clip 1160 (see FIG. 75 ),such as during an atrial appendage occlusion clip deployment surgicalprocedure. A more detailed explanation of the respective components ofthe handle mechanism 1318 follows.

The repositionable handle 1320 includes an arcuate, ventral grippingsurface that may include a series of convex bumps longitudinally spacedapart to facilitate gripping by a user. Opposite the ventral grippingsurface is a corresponding interior surface from which a pair of spacedapart, parallel vertical walls 1330, 1332 extend. The vertical walls1330, 1332 are also connected to one another via a plurality of crosswalls 1334. The vertical walls 1330, 1332 each include a distalupstanding loop 1338 that provides a through opening in themedial-to-lateral direction to receive a axle 1340 extending from theright side housing 1230 around which the handle 1320 rotates. Extendingdistally from the loop 1338, the walls 1330, 1332 include a circularopening extending in the medial-to-lateral direction that receives a pin1344 in order to repositionably mount the drive plate 1322 to the handle1320.

The exemplary drive plate 1322 comprises an arcuate, flat plate sized tofit between the walls 1330, 1332 of the handle 1320. A distal end of theplate 1322 includes an opening to receive the pin 1344. Extendingproximally from the opening is an elongated, arcuate opening 1346adapted to receive a dowel 1348 extending from the interior of the rightside housing 1230. In this manner, the dowel 1348 is repositioned withrespect to the opening 1346 as the handle 1324 repositions the driveplate 1322. In exemplary form, the opening is partially defined by a lip1350 that acts to retain the dowel 1348 in a static position after thehandle 1320 is fully closed. At the same time, the proximal end of thedrive plate 1322 includes an orifice 1352 that receives a portion of thespring 1324 in order to bias the handle 1320 to the open position shownin FIG. 77 . The opposing end of the spring 1324 is mounted to a dowel1354 that extends from the interior of the right side housing 1320.

The controller 1210 also includes a removable stem 1360 that is seatedwithin the proximal port 1312 of the housings 1230, 1232. The removablestem 1360 is coupled to one or more clip release wires 492 (in thiscase, two clip release wires) that act to disconnect an occlusion clipfrom the clip deployment device 118. In this manner, the stem 1360 maybe removed from the proximal end of the controller 1210, thereby drawingthe release wire(s) proximally and disconnecting the occlusion clip fromthe clip deployment device 118. In this exemplary embodiment, the stem1360 is secured within the proximal port 1312 via a friction fit thatmay be overcome by the user applying pressure to the stem to move itproximally with respect to the controller 1210. But it is also withinthe scope of the disclosure to use detents or other affirmative releasemechanisms to release the stem 1360 from the controller 1210.

Following from the above description and invention summaries, it shouldbe apparent to those of ordinary skill in the art that, while themethods and apparatuses herein described constitute exemplaryembodiments of the present invention, the invention is not limited tothe foregoing and changes may be made to such embodiments withoutdeparting from the scope of the invention as defined by the claims.Additionally, it is to be understood that the invention is defined bythe claims and it is not intended that any limitations or elementsdescribing the exemplary embodiments set forth herein are to beincorporated into the interpretation of any claim element unless suchlimitation or element is explicitly stated. Likewise, it is to beunderstood that it is not necessary to meet any or all of the identifiedadvantages or objects of the invention disclosed herein in order to fallwithin the scope of any claims, since the invention is defined by theclaims and since inherent and/or unforeseen advantages of the presentinvention may exist even though they may not have been explicitlydiscussed herein.

What is claimed is: 1.-68. (canceled)
 69. A medical instrumentcontroller comprising: a hand-held control including a plurality ofcontrols at least partially received within a housing; the plurality ofcontrols comprises: a first wheel rotationally repositionable withrespect to the housing, the first wheel is operatively coupled to afirst wire extending beyond the housing so that rotation of the firstwheel in a first direction increases a length of the first wire withinthe housing, and rotation of the first wheel in a second direction,opposite the first direction, decreases the length of the first wirewithin the housing; a second wheel rotationally repositionable withrespect to the housing, the second wheel is operatively coupled to asecond wire extending beyond the housing so that rotation of the secondwheel in a first direction increases a length of the second wire withinthe housing, and rotation of the second wheel in a second direction,opposite the first direction, decreases the length of the second wirewithin the housing; and, a handle repositionably mounted to the housing,the handle being operatively coupled to a third wire extending beyondthe housing so that repositioning the repositionable handle with respectto the housing causes repositioning of the third wire with respect tothe housing.